Provider Demographics
NPI:1114601879
Name:COX TOMICH, LIANE MARIE (RD)
Entity Type:Individual
Prefix:
First Name:LIANE
Middle Name:MARIE
Last Name:COX TOMICH
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 1:2910 VENEZIA LN
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-1768
Mailing Address - Country:US
Mailing Address - Phone:310-795-2241
Mailing Address - Fax:
Practice Address - Street 1:5743 CORSA AVE STE 210
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-7351
Practice Address - Country:US
Practice Address - Phone:310-795-2241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA813041133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered