Active NPI
Josephine Hadiwidjojo, MS, RD, CDN
- Registered Dietitian
- Porter Ranch, CA
National Provider Identifier
1164920476
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 832433
- Practice address
- 19936 Mariposa Creek Way
Porter Ranch, CA 91326-4128 - Phone
- (818) 585-1163
- NPI assigned
- Feb 1, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 832433 | CA | Primary |
Addresses
Primary practice location
19936 Mariposa Creek Way
Porter Ranch, CA 91326-4128
Mailing address
19936 Mariposa Creek Way
Porter Ranch, CA 91326-4128
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 832433 | CA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1517443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1517443200000",
"number": "1164920476",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19936 MARIPOSA CREEK WAY",
"city": "PORTER RANCH",
"state": "CA",
"postal_code": "913264128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19936 MARIPOSA CREEK WAY",
"city": "PORTER RANCH",
"state": "CA",
"postal_code": "913264128",
"telephone_number": "818-585-1163"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HADIWIDJOJO",
"first_name": "JOSEPHINE",
"credential": "MS, RD, CDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-02-01",
"last_updated": "2018-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "832433",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Porter Ranch, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.