Provider Demographics
NPI:1932400157
Name:CACHOLA, STANLEY UJANO (RD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:UJANO
Last Name:CACHOLA
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 MACKAY LN # B
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3702
Mailing Address - Country:US
Mailing Address - Phone:310-910-4737
Mailing Address - Fax:
Practice Address - Street 1:1703 MACKAY LN # B
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3702
Practice Address - Country:US
Practice Address - Phone:310-910-4737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85007919133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered