Healthcare Provider Details

I. General information

NPI: 1225592918
Provider Name (Legal Business Name): REILLY BROWN MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2019
Last Update Date: 01/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11825 MAJOR ST STE 107
LOS ANGELES CA
90230-6356
US

IV. Provider business mailing address

5535 WESTLAWN AVE APT 366
LOS ANGELES CA
90066-7140
US

V. Phone/Fax

Practice location:
  • Phone: 310-915-6100
  • Fax: 310-915-0100
Mailing address:
  • Phone: 424-346-3037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: