Provider Demographics
NPI:1508484429
Name:WESTON, EVA DESSERRE
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:DESSERRE
Last Name:WESTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53007
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90053-0007
Mailing Address - Country:US
Mailing Address - Phone:832-338-4161
Mailing Address - Fax:
Practice Address - Street 1:2304 RIEGEL DR
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-4624
Practice Address - Country:US
Practice Address - Phone:832-338-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered