Provider Demographics
NPI:1568738433
Name:KELLEY, CLAUDIA (PHD, RD, CDE)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PHD, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10417 DITSON ST
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-1411
Mailing Address - Country:US
Mailing Address - Phone:818-768-5567
Mailing Address - Fax:
Practice Address - Street 1:10417 DITSON ST
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-1411
Practice Address - Country:US
Practice Address - Phone:818-768-5567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA870778133V00000X
CA2031-0216133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered