Provider Demographics
NPI:1417351776
Name:HO, PRISCA (RD, RN)
Entity Type:Individual
Prefix:
First Name:PRISCA
Middle Name:
Last Name:HO
Suffix:
Gender:F
Credentials:RD, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1901
Mailing Address - Country:US
Mailing Address - Phone:213-977-2344
Mailing Address - Fax:
Practice Address - Street 1:637 LUCAS AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1997
Practice Address - Country:US
Practice Address - Phone:213-977-2344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA923590133NN1002X, 133V00000X
CA769918163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No163W00000XNursing Service ProvidersRegistered Nurse