Provider Demographics
NPI:1477639557
Name:OLDENBURG, JULIE LYN (RD, CDE)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LYN
Last Name:OLDENBURG
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:LYN
Other - Last Name:HAVICKHORST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CDE
Mailing Address - Street 1:2503 E 21ST ST APT 104
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-6029
Mailing Address - Country:US
Mailing Address - Phone:562-597-2502
Mailing Address - Fax:
Practice Address - Street 1:501 E HARDY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4054
Practice Address - Country:US
Practice Address - Phone:310-680-4500
Practice Address - Fax:310-680-4505
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered