Healthcare Provider Details

I. General information

NPI: 1508484429
Provider Name (Legal Business Name): EVA DESSERRE WESTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 RIEGEL DR
ALHAMBRA CA
91803-4624
US

IV. Provider business mailing address

PO BOX 53007
LOS ANGELES CA
90053-0007
US

V. Phone/Fax

Practice location:
  • Phone: 832-338-4161
  • Fax:
Mailing address:
  • Phone: 832-338-4161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: