MEDICARE: MS. BARBARA SUSAN RAVID RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1013272251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BARBARA SUSAN RAVID RD

Provider Business Mailing Address
First Line	:	4603 MONOGRAM AVE
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90713-2740
Country	:	US
Telephone Number	:	562-421-4647
Fax Number	:

Provider Business Practice Location Address
First Line	:	3780 KILROY AIRPORT WAY STE 110
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2458
Country	:	US
Telephone Number	:	562-897-1460
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2012
Last Update Date	:	07/12/2012

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