Provider Demographics
NPI:1295368231
Name:RAZMPOOSH, ELENA C (MS, RD)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:C
Last Name:RAZMPOOSH
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 1:3005 124TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1621
Mailing Address - Country:US
Mailing Address - Phone:805-231-1517
Mailing Address - Fax:
Practice Address - Street 1:3005 124TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1621
Practice Address - Country:US
Practice Address - Phone:805-231-1517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered