Provider Demographics
NPI:1164241279
Name:EDRADAN, RIZZA MAGBUHAT (CSR, RDN, LDN)
Entity type:Individual
Prefix:
First Name:RIZZA
Middle Name:MAGBUHAT
Last Name:EDRADAN
Suffix:
Gender:F
Credentials:CSR, RDN, LDN
Other - Prefix:
Other - First Name:RIZZA MARIE
Other - Middle Name:TUVIDA
Other - Last Name:MAGBUHAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RIZZA MARIE MAGBUHAT
Mailing Address - Street 1:337 RIVELLA DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-3639
Mailing Address - Country:US
Mailing Address - Phone:415-867-4422
Mailing Address - Fax:
Practice Address - Street 1:337 RIVELLA DR
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-3639
Practice Address - Country:US
Practice Address - Phone:415-867-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005028133V00000X
FLND1244133V00000X
CA86036227133V00000X
NC86036227133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal