=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134905904
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TORRANCE MEMORIAL MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2023
-----------------------------------------------------
Last Update Date | 09/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2841 LOMITA BLVD. SUITE 335 MEDICAL NUTRITION THERAPY
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-891-6707
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3330 LOMITA BLVD NUTRITION SERVICES
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-325-9110
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGISTERED DIETITIAN NUTRITIONIST
-----------------------------------------------------
Name | MRS. DUONG THAI BINH LE
-----------------------------------------------------
Credential | RDN
-----------------------------------------------------
Telephone | 310-325-9110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------