Active NPI
Khadeja Ghaniezadeh
- Registered Dietitian
- Loma Linda, CA
National Provider Identifier
1295511889
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86074510
- Practice address
- 11201 Benton St
Loma Linda, CA 92357-1000 - Phone
- (909) 825-7084
- NPI assigned
- Sep 7, 2023
- Sex
- Female
- Sole proprietor
- No
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 | 86074510 | CA | Primary |
Addresses
Primary practice location
11201 Benton St
Loma Linda, CA 92357-1000
Mailing address
11792 Randolph CT
Loma Linda, CA 92354-4188
Phone (909) 894-6905
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86074510 | CA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1694044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710374400000",
"number": "1295511889",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11792 RANDOLPH CT",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923544188",
"telephone_number": "909-894-6905"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11201 BENTON ST",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923571000",
"telephone_number": "909-825-7084"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GHANIEZADEH",
"first_name": "KHADEJA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-09-07",
"last_updated": "2024-03-14",
"certification_date": "2024-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "86074510",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Loma Linda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.