MEDICARE: DR. MANIJEH NEZAMI DR PH , RDN

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	897887	CA

General Provider Information

NPI Number	:	1457809394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANIJEH NEZAMI DR PH , RDN

Provider Business Mailing Address
First Line	:	820 S BEDFORD ST
Second Line	:	UNIT 103
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1895
Country	:	US
Telephone Number	:	310-962-9308
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 S BEDFORD ST
Second Line	:	UNIT 103
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1895
Country	:	US
Telephone Number	:	310-962-9308
Fax Number	:

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

Provider Enumeration Date	:	09/20/2016
Last Update Date	:	09/20/2016

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