MEDICARE: YEVGENIYA BORISOVNA DARMANYAN

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	886138

General Provider Information

NPI Number	:	1346381803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YEVGENIYA BORISOVNA DARMANYAN

Provider Business Mailing Address
First Line	:	8400 DE LONGPRE AVE
Second Line	:	# 213
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-2624
Country	:	US
Telephone Number	:	323-650-5158
Fax Number	:

Provider Business Practice Location Address
First Line	:	7559 SANTA MONICA BLVD
Second Line	:	2ND FLOOR
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-6406
Country	:	US
Telephone Number	:	323-878-2523
Fax Number	:

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	07/08/2007

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