Provider Demographics
NPI:1619365970
Name:ABDUL-KARIM, ANITA
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:ABDUL-KARIM
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 1:629 ROYAL VIEW ST
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-1346
Mailing Address - Country:US
Mailing Address - Phone:626-466-7040
Mailing Address - Fax:
Practice Address - Street 1:3728 VALLEY LIGHTS DR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-1342
Practice Address - Country:US
Practice Address - Phone:626-466-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86056706133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered