MEDICARE: ANN MO RD

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
2	133VN1005X	Renal Nutrition Registered Dietitian

General Provider Information

NPI Number	:	1649610049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN MO RD

Provider Business Mailing Address
First Line	:	3510 E HILLHAVEN DR
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91791-1719
Country	:	US
Telephone Number	:	626-416-8566
Fax Number	:

Provider Business Practice Location Address
First Line	:	158 W COLLEGE ST
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91723-2007
Country	:	US
Telephone Number	:	626-859-2522
Fax Number	:	626-331-0175

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

Provider Enumeration Date	:	06/28/2013
Last Update Date	:	06/28/2013

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Directions to “ ANN MO RD” Practice Location

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