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NPI Code Detail

MEDICARE: CAROL JEAN SCROGGS RD, CDCES

MEDICARE: CAROL JEAN SCROGGS RD, CDCES
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 Dietitian

General Provider Information

NPI Number : 1326245127
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROL JEAN SCROGGS RD, CDCES
Provider Business Mailing Address
First Line : 230 N KENWOOD ST APT 320
Second Line :
City : BURBANK
State : CA
Zip : 91505-3979
Country : US
Telephone Number : 310-291-7109
Fax Number : 323-783-5912
Provider Business Practice Location Address
First Line : 4700 SUNSET BLVD
Second Line : 3C PEDIATRICS
City : LOS ANGELES
State : CA
Zip : 90027-6070
Country : US
Telephone Number : 323-783-1063
Fax Number : 323-783-5912
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2007
Last Update Date : 11/11/2021

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