Provider Demographics
NPI:1225546708
Name:SWANSON, RACHEL E (RDN)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:E
Last Name:SWANSON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 WILSHIRE BLVD STE 610
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4814
Mailing Address - Country:US
Mailing Address - Phone:310-453-2335
Mailing Address - Fax:214-393-4645
Practice Address - Street 1:2811 WILSHIRE BLVD STE 610
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4814
Practice Address - Country:US
Practice Address - Phone:310-453-2335
Practice Address - Fax:214-393-4645
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
CA008995133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered