Provider Demographics
NPI:1326245127
Name:SCROGGS, CAROL JEAN (RD, CDCES)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JEAN
Last Name:SCROGGS
Suffix:
Gender:F
Credentials:RD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 N KENWOOD ST APT 320
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-3979
Mailing Address - Country:US
Mailing Address - Phone:310-291-7109
Mailing Address - Fax:323-783-5912
Practice Address - Street 1:4700 SUNSET BLVD
Practice Address - Street 2:3C PEDIATRICS
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6070
Practice Address - Country:US
Practice Address - Phone:323-783-1063
Practice Address - Fax:323-783-5912
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered