Healthcare Provider Details

I. General information

NPI: 1861795791
Provider Name (Legal Business Name): ANDREA LEE MILTON RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2010
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7722 CAPISTRANO AVE
WEST HILLS CA
91304-5404
US

IV. Provider business mailing address

7722 CAPISTRANO AVE
WEST HILLS CA
91304-5404
US

V. Phone/Fax

Practice location:
  • Phone: 818-317-5636
  • Fax: 818-912-6516
Mailing address:
  • Phone: 818-317-5636
  • Fax: 818-912-6516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number859147
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: