Provider Demographics
NPI:1346381803
Name:DARMANYAN, YEVGENIYA BORISOVNA
Entity Type:Individual
Prefix:
First Name:YEVGENIYA
Middle Name:BORISOVNA
Last Name:DARMANYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YEVGENIYA
Other - Middle Name:BORISOVNA
Other - Last Name:KOROBOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:8400 DE LONGPRE AVE
Mailing Address - Street 2:# 213
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-2624
Mailing Address - Country:US
Mailing Address - Phone:323-650-5158
Mailing Address - Fax:
Practice Address - Street 1:7559 SANTA MONICA BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-6406
Practice Address - Country:US
Practice Address - Phone:323-878-2523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
886138133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNT 886138BMedicare ID - Type UnspecifiedPPIN