Healthcare Provider Details

I. General information

NPI: 1255484135
Provider Name (Legal Business Name): MARY NORRIS FELANDO MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 S SAN VICENTE BLVD SUITE 901
LOS ANGELES CA
90048-4165
US

IV. Provider business mailing address

12062 ARGYLE DR
LOS ALAMITOS CA
90720-4408
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-9660
  • Fax:
Mailing address:
  • Phone: 562-596-5188
  • Fax: 310-423-9668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number528405
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number520405
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: