SD Medical Nutrition Therapy, PC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

SD MEDICAL NUTRITION THERAPY, PC

Practice address

11365 Mandrake PT
San Diego, CA 92131-3766

Phone

(619) 736-9020

NPI assigned

Apr 3, 2024

Organization subpart

No

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

Authorized official

Name

Andrea I Zajac, RDNNPI 1144083775

Title

Owner

Phone

(808) 554-2811

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Andrea I Zajac, RDN

  • Registered Dietitian
  • San Diego, CA
  • NPI 1144083775
  Authorized official Same address or phone

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

{
    "created_epoch": "1712102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712102400000",
    "number": "1861244774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11365 MANDRAKE PT",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921313766",
            "telephone_number": "619-736-9020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11365 MANDRAKE PT",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921313766",
            "telephone_number": "619-736-9020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SD MEDICAL NUTRITION THERAPY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-03",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A",
        "authorized_official_last_name": "ZAJAC",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "808-554-2811",
        "authorized_official_credential": "RDN"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in San Diego, CA
• Providers in San Diego, CA by specialty
• Registered Dietitian in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 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.

Verify at the official NPI Registry.