Healthcare Provider Details

I. General information

NPI: 1790941144
Provider Name (Legal Business Name): LEE ANN SMITH WEINTRAUB MPH, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEEANN SMITH MPH, RD

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9696 CULVER BLVD STE 301
CULVER CITY CA
90232-2759
US

IV. Provider business mailing address

9696 CULVER BLVD STE 301
CULVER CITY CA
90232-2759
US

V. Phone/Fax

Practice location:
  • Phone: 310-562-4313
  • Fax: 310-427-7445
Mailing address:
  • Phone: 310-562-4313
  • Fax: 310-427-7445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number922543
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number922543
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: