Provider Demographics
NPI:1194191551
Name:ROTHSCHILD, JEFFREY (MS, RD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:ROTHSCHILD
Suffix:
Gender:M
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 N OLIVE DR APT 209
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-2734
Mailing Address - Country:US
Mailing Address - Phone:323-854-5103
Mailing Address - Fax:
Practice Address - Street 1:2425 COLORADO AVE STE 120
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-3542
Practice Address - Country:US
Practice Address - Phone:210-829-2420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86032679133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered