Provider Demographics
NPI:1215549449
Name:WOMACK, ZOE DELANEY (RDN, MPH)
Entity Type:Individual
Prefix:
First Name:ZOE
Middle Name:DELANEY
Last Name:WOMACK
Suffix:
Gender:F
Credentials:RDN, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10528 LAURISTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2315
Mailing Address - Country:US
Mailing Address - Phone:520-309-8600
Mailing Address - Fax:
Practice Address - Street 1:10528 LAURISTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-2315
Practice Address - Country:US
Practice Address - Phone:520-309-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133VN1004X
CA86175115133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric