MEDICARE: ELHAM SOUFERZADEH MS RD

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	133V00000X	Registered Dietitian	1018770	CA

General Provider Information

NPI Number	:	1336541606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELHAM SOUFERZADEH MS RD

Provider Business Mailing Address
First Line	:	2240 BOWMONT DR
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-1807
Country	:	US
Telephone Number	:	310-400-4702
Fax Number	:

Provider Business Practice Location Address
First Line	:	2240 BOWMONT DR
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-1807
Country	:	US
Telephone Number	:	310-400-4702
Fax Number	:

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

Provider Enumeration Date	:	09/18/2014
Last Update Date	:	09/18/2014

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