Healthcare Provider Details

I. General information

NPI: 1457748360
Provider Name (Legal Business Name): LORENA VARELA REGISTERED DIETITIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 POMONA BLVD
LOS ANGELES CA
90022-1753
US

IV. Provider business mailing address

5255 POMONA BLVD
LOS ANGELES CA
90022-1753
US

V. Phone/Fax

Practice location:
  • Phone: 323-832-7683
  • Fax: 323-832-7599
Mailing address:
  • Phone: 323-832-7683
  • Fax: 323-832-7599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86016935
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: