MEDICARE: FAZA DIETETICS LLC

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	:	1447538491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAZA DIETETICS LLC

Provider Business Mailing Address
First Line	:	8491 W SUNSET BLVD # 438
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-1911
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8491 W SUNSET BLVD # 438
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-1911
Country	:	US
Telephone Number	:	310-230-5741
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ROBERT SILVERMAN
Credential	:
Telephone Number	:	310-230-5741

Provider Enumeration Date	:	07/25/2011
Last Update Date	:	07/25/2011

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