Healthcare Provider Details

I. General information

NPI: 1134883416
Provider Name (Legal Business Name): JESSICA LYNN LA MONS MS, RDN, CSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2021
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12304 SANTA MONICA BLVD STE 212
LOS ANGELES CA
90025-2587
US

IV. Provider business mailing address

PO BOX 9985
SAN JOSE CA
95157-0985
US

V. Phone/Fax

Practice location:
  • Phone: 646-390-5066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: