Healthcare Provider Details

I. General information

NPI: 1376800938
Provider Name (Legal Business Name): EDUCARE NUTRITION AND DIABETES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22554 VENTURA BLVD 205
WOODLAND HILLS CA
91364-1413
US

IV. Provider business mailing address

22554 VENTURA BLVD 205
WOODLAND HILLS CA
91364-1413
US

V. Phone/Fax

Practice location:
  • Phone: 818-330-4021
  • Fax:
Mailing address:
  • Phone: 818-330-4021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number859147
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: ANDREA MILTON
Title or Position: OWNER
Credential: RD, CDE
Phone: 818-330-4021