Provider Demographics
NPI:1114032547
Name:FELDMAN, MARIE D (RD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:D
Last Name:FELDMAN
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 1:16030 VENTURA BLVD
Mailing Address - Street 2:SUITE 680
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2731
Mailing Address - Country:US
Mailing Address - Phone:818-990-1067
Mailing Address - Fax:818-981-1217
Practice Address - Street 1:16030 VENTURA BLVD
Practice Address - Street 2:SUITE 680
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2731
Practice Address - Country:US
Practice Address - Phone:818-990-1067
Practice Address - Fax:818-981-1217
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
863357133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
863357OtherREGISTERED DIETITIAN
863357OtherREGISTERED DIETITIAN