Healthcare Provider Details

I. General information

NPI: 1326343328
Provider Name (Legal Business Name): NAZILA NIKRAVESH RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2011
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 SOUTH SHERBOURNE # 7
LOS ANGELES CA
90035
US

IV. Provider business mailing address

1114 S SHERBOURNE DR APT 7
LOS ANGELES CA
90035-2335
US

V. Phone/Fax

Practice location:
  • Phone: 310-666-9792
  • Fax:
Mailing address:
  • Phone: 310-666-9792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number968744
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number968744
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: