Provider Demographics
NPI:1619353067
Name:WISS, DAVID ANDREW (MS, RDN)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ANDREW
Last Name:WISS
Suffix:
Gender:M
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2250 PARNELL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2005
Mailing Address - Country:US
Mailing Address - Phone:310-403-1874
Mailing Address - Fax:310-470-7969
Practice Address - Street 1:8549 WILSHIRE BLVD
Practice Address - Street 2:SUITE 646
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3104
Practice Address - Country:US
Practice Address - Phone:310-403-1874
Practice Address - Fax:310-470-7969
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-08
Last Update Date:2015-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1089886133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered