Healthcare Provider Details

I. General information

NPI: 1447538491
Provider Name (Legal Business Name): FAZA DIETETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8491 W SUNSET BLVD # 438
WEST HOLLYWOOD CA
90069-1911
US

IV. Provider business mailing address

8491 W SUNSET BLVD # 438
WEST HOLLYWOOD CA
90069-1911
US

V. Phone/Fax

Practice location:
  • Phone: 310-230-5741
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROBERT SILVERMAN
Title or Position: MANAGER
Credential:
Phone: 310-230-5741