Provider Demographics
NPI:1104375385
Name:BARON COLE, ELIZABETH (RDN, CHFS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BARON COLE
Suffix:
Gender:F
Credentials:RDN, CHFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 WILSHIRE BLVD
Mailing Address - Street 2:STE 302
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5720
Mailing Address - Country:US
Mailing Address - Phone:310-453-5212
Mailing Address - Fax:310-829-0891
Practice Address - Street 1:2121 WILSHIRE BLVD
Practice Address - Street 2:STE 302
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5720
Practice Address - Country:US
Practice Address - Phone:310-453-5212
Practice Address - Fax:310-829-0891
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA667488133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered