MEDICARE: KRISTINA HALVERSON R.D.

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	86068199	CA

General Provider Information

NPI Number	:	1952840811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA HALVERSON R.D.

Provider Business Mailing Address
First Line	:	1930 OCEAN AVE APT 116
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-1040
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1930 OCEAN AVE APT 116
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-1040
Country	:	US
Telephone Number	:	504-281-0593
Fax Number	:

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

Provider Enumeration Date	:	02/13/2017
Last Update Date	:	02/13/2017

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