MEDICARE: JOHN SIRITARANUKUL 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	1082098	CA

General Provider Information

NPI Number	:	1891149118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN SIRITARANUKUL RD

Provider Business Mailing Address
First Line	:	2716 OCEAN PARK BLVD
Second Line	:	SUITE 3020
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-5207
Country	:	US
Telephone Number	:	310-829-9161
Fax Number	:	310-919-3567

Provider Business Practice Location Address
First Line	:	2716 OCEAN PARK BLVD
Second Line	:	SUITE 3020
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-5207
Country	:	US
Telephone Number	:	310-829-9161
Fax Number	:	310-919-3567

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

Provider Enumeration Date	:	04/22/2016
Last Update Date	:	01/03/2022

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