Provider Demographics
NPI:1396185112
Name:VARTANI, ANI (MS, RD)
Entity Type:Individual
Prefix:
First Name:ANI
Middle Name:
Last Name:VARTANI
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 1:1980 N ORANGE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3008
Mailing Address - Country:US
Mailing Address - Phone:310-273-8094
Mailing Address - Fax:
Practice Address - Street 1:520 E BROADWAY
Practice Address - Street 2:STE 302
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4943
Practice Address - Country:US
Practice Address - Phone:310-273-8094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1026824133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered