Provider Demographics
NPI:1083836308
Name:PARKS, ELIZABETH ANN (RD)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:PARKS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 W. COLLEGE ST.
Mailing Address - Street 2:FOOD & NUTRITION SERVICES DEPT.
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-5923
Mailing Address - Country:US
Mailing Address - Phone:213-580-7298
Mailing Address - Fax:213-580-7386
Practice Address - Street 1:765 W. COLLEGE ST.
Practice Address - Street 2:FOOD & NUTRITION SERVICES DEPT.
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-5923
Practice Address - Country:US
Practice Address - Phone:213-580-7298
Practice Address - Fax:213-580-7386
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR421467133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR421467OtherREGISTERED DIETITIAN