Alfreda Sulistiowati

Primary specialty

Nutrition Education NutritionistTaxonomy code 133NN1002X

License

1099864 Issued in CA

Practice address

24850 Prospect Ave Apt D
Loma Linda, CA 92354-2843

Phone

(310) 309-1644

NPI assigned

Jun 1, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fay Nutrition

  • Registered Dietitian
  • San Francisco, CA
  • NPI 1104334465
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1338508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338508800000",
    "number": "1699036053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24850 PROSPECT AVE APT D",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542843",
            "telephone_number": "310-309-1644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24850 PROSPECT AVE APT D",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542843",
            "telephone_number": "310-309-1644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULISTIOWATI",
        "first_name": "ALFREDA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-01",
        "last_updated": "2012-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "CA",
            "license": "1099864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen N Stutz, DO
• Reece Alan Stutzman
• Diana Beatrice Su-Erickson, OTR/L
• Prajan Subedi
• Jennelle Suchecki
• Whitney Alison Sullivan-Lewis, M.D.
• Rosemary Sullivan, MA, OTR/L
• Jennifer Sumarauw, BA
• Alexander Nicolas Sumarli, MD
• Samantha Sumarli

• Nutrition Education Nutritionist in Loma Linda, CA
• Providers in Loma Linda, CA by specialty
• Nutrition Education Nutritionist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.