Provider Demographics
NPI:1225592918
Name:BROWN, REILLY (MS, RD)
Entity Type:Individual
Prefix:
First Name:REILLY
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
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 1:5535 WESTLAWN AVE APT 366
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-7140
Mailing Address - Country:US
Mailing Address - Phone:424-346-3037
Mailing Address - Fax:
Practice Address - Street 1:11825 MAJOR ST STE 107
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90230-6356
Practice Address - Country:US
Practice Address - Phone:310-915-6100
Practice Address - Fax:310-915-0100
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-26
Last Update Date:2019-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered