Healthcare Provider Details

I. General information

NPI: 1982489233
Provider Name (Legal Business Name): JESSICA RAE MURRAY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 HILLHURST AVE
LOS ANGELES CA
90027-5516
US

IV. Provider business mailing address

4216 FOUNTAIN AVE
LOS ANGELES CA
90029-2256
US

V. Phone/Fax

Practice location:
  • Phone: 323-644-3880
  • Fax: 323-660-0935
Mailing address:
  • Phone: 323-644-3880
  • Fax: 323-660-0935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: