Provider Demographics
NPI:1255484135
Name:FELANDO, MARY NORRIS (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:NORRIS
Last Name:FELANDO
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 1:12062 ARGYLE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-4408
Mailing Address - Country:US
Mailing Address - Phone:562-596-5188
Mailing Address - Fax:310-423-9668
Practice Address - Street 1:444 S SAN VICENTE BLVD
Practice Address - Street 2:SUITE 901
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4165
Practice Address - Country:US
Practice Address - Phone:310-423-9660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA528405133V00000X
CA520405133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Not Answered133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic