MEDICARE: NOURISHING DIRECTION INC

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	207R00000X	Internal Medicine Physician	G57217	CA

General Provider Information

NPI Number	:	1073745238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOURISHING DIRECTION INC

Provider Business Mailing Address
First Line	:	10573 W PICO BLVD
Second Line	:	STE 289
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2333
Country	:	US
Telephone Number	:	323-354-0838
Fax Number	:

Provider Business Practice Location Address
First Line	:	3954 CITY TERRACE DR
Second Line	:	STE 101
City	:	LOS ANGELES
State	:	CA
Zip	:	90063-1241
Country	:	US
Telephone Number	:	323-354-0838
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	ANITA A WALTON
Credential	:	M.D.
Telephone Number	:	323-354-0838

Provider Enumeration Date	:	08/20/2009
Last Update Date	:	08/20/2009

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