Provider Demographics
NPI:1477056711
Name:MARDER, ELANA (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:ELANA
Middle Name:
Last Name:MARDER
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3133 EVENING WAY UNIT B
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1615
Mailing Address - Country:US
Mailing Address - Phone:610-457-4984
Mailing Address - Fax:
Practice Address - Street 1:3133 EVENING WAY UNIT B
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1615
Practice Address - Country:US
Practice Address - Phone:610-457-4984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86037083133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered