Basic Information
| Provider Information | |||||||||
| NPI: | 1578865184 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHUSID | ||||||||
| FirstName: | DEENA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4290 POLK AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921051524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195630250 | ||||||||
| FaxNumber: | 8586334681 | ||||||||
| Practice Location | |||||||||
| Address1: | 4290 POLK AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921051524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195630250 | ||||||||
| FaxNumber: | 8586334681 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2010 | ||||||||
| LastUpdateDate: | 03/12/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.