MEDICARE: ACADEMY OF NUTRITION AND DIETETICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QA0600X	Adult Day Care Clinic/Center
2	261QC1500X	Community Health Clinic/Center
3	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1851848659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACADEMY OF NUTRITION AND DIETETICS

Provider Business Mailing Address
First Line	:	4537 DON TONITO DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-4114
Country	:	US
Telephone Number	:	323-299-8521
Fax Number	:	323-299-8521

Provider Business Practice Location Address
First Line	:	4537 DON TONITO DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-4114
Country	:	US
Telephone Number	:	323-299-8521
Fax Number	:	323-299-8521

Authorized Official
Title or Position	:	REGISTERED DIETITIAN/NUTRITIONIST
Name	:	COMFORT IJEOMA OGBUNAMIRI
Credential	:	MS,RDN,FAND
Telephone Number	:	323-299-8521

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

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