MEDICARE: MR. TOM LAWSON DIGBY CHHP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1043631187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TOM LAWSON DIGBY CHHP

Provider Business Mailing Address
First Line	:	1942 PREUSS RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-1107
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1942 PREUSS RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-1107
Country	:	US
Telephone Number	:	310-770-8072
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2013
Last Update Date	:	12/16/2013

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