Provider Demographics
NPI:1497771430
Name:NEIRICK, NANCY (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:NEIRICK
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8631 WEST 3RD STREET
Mailing Address - Street 2:SUITE #1030 E.
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048
Mailing Address - Country:US
Mailing Address - Phone:310-652-8446
Mailing Address - Fax:310-652-4394
Practice Address - Street 1:8631 W 3RD ST
Practice Address - Street 2:SUITE # 1030E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:310-652-8446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA931493133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMNT 931493Medicare ID - Type UnspecifiedDIETITIAN