Provider Demographics
NPI:1104193424
Name:SOUFFRONT, JANINE (RD)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:SOUFFRONT
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 1:4159 CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-3961
Mailing Address - Country:US
Mailing Address - Phone:323-226-1169
Mailing Address - Fax:
Practice Address - Street 1:4159 CAMINO REAL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-3961
Practice Address - Country:US
Practice Address - Phone:323-226-1169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered