Provider Demographics
NPI:1932987203
Name:HSIEH, CHARLEEN (MPH, RDN)
Entity Type:Individual
Prefix:
First Name:CHARLEEN
Middle Name:
Last Name:HSIEH
Suffix:
Gender:F
Credentials:MPH, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3228 CRANE AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-6218
Mailing Address - Country:US
Mailing Address - Phone:858-877-0877
Mailing Address - Fax:
Practice Address - Street 1:3228 CRANE AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-6218
Practice Address - Country:US
Practice Address - Phone:858-877-0877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86150034133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered