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NPI Code Detail

MEDICARE: KATHRYN RIAL RD

MEDICARE: KATHRYN RIAL 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
1133V00000XRegistered DietitianCA

General Provider Information

NPI Number : 1114885373
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN RIAL RD
Provider Business Mailing Address
First Line : 720 WILSHIRE BLVD STE 204
Second Line :
City : SANTA MONICA
State : CA
Zip : 90401-1737
Country : US
Telephone Number : 323-250-3905
Fax Number : 323-822-3384
Provider Business Practice Location Address
First Line : 720 WILSHIRE BLVD STE 204
Second Line :
City : SANTA MONICA
State : CA
Zip : 90401-1737
Country : US
Telephone Number : 323-250-3905
Fax Number : 323-822-3384
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2026
Last Update Date : 03/19/2026

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