Provider Demographics
NPI:1386189892
Name:LYDEEN, VICTORIA LYNN (MS, RDN, CSR)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNN
Last Name:LYDEEN
Suffix:
Gender:F
Credentials:MS, RDN, CSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 E COLORADO BLVD # 2501
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1903
Mailing Address - Country:US
Mailing Address - Phone:818-207-4225
Mailing Address - Fax:626-628-3050
Practice Address - Street 1:5594 SORIA DR
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91762-7646
Practice Address - Country:US
Practice Address - Phone:818-207-4225
Practice Address - Fax:626-625-3050
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-20
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86017647133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered