MEDICARE: RYOKO GRACE ODA

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	1063468	CA

General Provider Information

NPI Number	:	1407745250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYOKO GRACE ODA

Provider Business Mailing Address
First Line	:	5541 LAUREL CANYON BLVD APT 3
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-2131
Country	:	US
Telephone Number	:	310-493-9539
Fax Number	:

Provider Business Practice Location Address
First Line	:	5541 LAUREL CANYON BLVD APT 3
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-2131
Country	:	US
Telephone Number	:	310-493-9539
Fax Number	:

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

Provider Enumeration Date	:	06/28/2025
Last Update Date	:	06/28/2025

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Directions to “ RYOKO GRACE ODA ” Practice Location

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