Provider Demographics
NPI:1447382213
Name:AL-DANDACHI, LARA NAWAF (RD)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:NAWAF
Last Name:AL-DANDACHI
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 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 UCLA MEDICAL PLZ STE 530
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-4982
Practice Address - Country:US
Practice Address - Phone:310-825-7922
Practice Address - Fax:310-267-1899
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21520284133V00000X
CA945298133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA945298OtherAM. DIETERIC ASSOCIATION