Provider Demographics
NPI:1750573879
Name:MCLAY, SUZANNE (RD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:MCLAY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E REDLANDS BLVD
Mailing Address - Street 2:#U-190
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-6143
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 E REDLANDS BLVD
Practice Address - Street 2:#U-190
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-6143
Practice Address - Country:US
Practice Address - Phone:909-335-9350
Practice Address - Fax:909-335-9591
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA942853133V00000X, 133VN1005X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic