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NPI Code Detail

MEDICARE: FATIMA CABRAL RD

MEDICARE: FATIMA CABRAL 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
1133V00000XRegistered Dietitian

General Provider Information

NPI Number : 1790746329
Entity Type Code : Individual
Provider Name (Legal Business Name) : FATIMA CABRAL RD
Provider Business Mailing Address
First Line : 1420 15TH ST
Second Line : UNIT A
City : MANHATTAN BEACH
State : CA
Zip : 90266-4067
Country : US
Telephone Number : 310-546-8751
Fax Number :
Provider Business Practice Location Address
First Line : 1500 SAN PABLO ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90033-5313
Country : US
Telephone Number : 323-442-8443
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2006
Last Update Date : 07/08/2007

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