Healthcare Provider Details

I. General information

NPI: 1891010575
Provider Name (Legal Business Name): ANURADHA RAGHUPATHI MANTHRIPRAGADA MS, RD, LDN, CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 MARENGO ST ROOM 1H212
LOS ANGELES CA
90033-1352
US

IV. Provider business mailing address

2051 MARENGO ST ROOM 1H 212
LOS ANGELES CA
90033-1352
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-6979
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL001281
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number813060
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: