Provider Demographics
NPI:1639906803
Name:ZANDIEH, NILOPHAR LILY (PHD, RD)
Entity type:Individual
Prefix:
First Name:NILOPHAR
Middle Name:LILY
Last Name:ZANDIEH
Suffix:
Gender:F
Credentials:PHD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31448 W NINE DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2951
Mailing Address - Country:US
Mailing Address - Phone:949-244-7504
Mailing Address - Fax:
Practice Address - Street 1:31448 W NINE DR
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2951
Practice Address - Country:US
Practice Address - Phone:949-244-7504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86099403133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty