Provider Demographics
NPI:1356851075
Name:COLE, DEVON ELIZABETH (RD)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:ELIZABETH
Last Name:COLE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N BRAND BLVD STE 213
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2641
Mailing Address - Country:US
Mailing Address - Phone:626-817-6907
Mailing Address - Fax:
Practice Address - Street 1:100 N BRAND BLVD STE 213
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2641
Practice Address - Country:US
Practice Address - Phone:626-817-6907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-08
Last Update Date:2017-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86022639133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered