Provider Demographics
NPI:1427534544
Name:DISHMAN, MARLA (RD)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:DISHMAN
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 1:631 OAK RUN TRL UNIT 201
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91377-5621
Mailing Address - Country:US
Mailing Address - Phone:818-515-0176
Mailing Address - Fax:
Practice Address - Street 1:631 OAK RUN TRL UNIT 201
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:CA
Practice Address - Zip Code:91377-5621
Practice Address - Country:US
Practice Address - Phone:818-515-0176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR469102133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered