Healthcare Provider Details

I. General information

NPI: 1801232574
Provider Name (Legal Business Name): LAUREN CORNELL M.S., R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S BARRINGTON AVE STE 103
LOS ANGELES CA
90025
US

IV. Provider business mailing address

1507 7TH ST # 175
SANTA MONICA CA
90401-2605
US

V. Phone/Fax

Practice location:
  • Phone: 424-259-3652
  • Fax: 424-258-9404
Mailing address:
  • Phone: 424-259-3652
  • Fax: 424-258-9404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86002647
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: