Healthcare Provider Details

I. General information

NPI: 1356478861
Provider Name (Legal Business Name): CHLA USC-UCEDD NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD USC - UCEDD NUTRITION, M.S. #53
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

PO BOX 27980 3250 SUNSET BLVD.
LOS ANGELES CA
90027-0980
US

V. Phone/Fax

Practice location:
  • Phone: 323-669-2300
  • Fax: 323-844-8305
Mailing address:
  • Phone: 323-669-2300
  • Fax: 323-844-8305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MARION TAYLOR BAER
Title or Position: NUTRITION DIRECTOR
Credential: R.D.
Phone: 323-669-2300