=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053597807
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTI SALEM CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2008
-----------------------------------------------------
Last Update Date | 01/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21243 VENTURA BLVD STE 137
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91364-2124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-399-3903
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5129 NEWCASTLE AVE
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91316-3512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-399-3903
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIETITIAN
-----------------------------------------------------
Name | MRS. CHRISTIANNE HAMILTON SALEM
-----------------------------------------------------
Credential | R.D
-----------------------------------------------------
Telephone | 818-399-3903
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 960887
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------