Provider Demographics
NPI: | 1619660677 |
---|---|
Name: | A&N NUTRITION SERVICE |
Entity Type: | Organization |
Organization Name: | A&N NUTRITION SERVICE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | REGISTERED DIETITIAN/OWNER |
Authorized Official - Prefix: | MISS |
Authorized Official - First Name: | KATELYN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | TRAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MPH, RDN |
Authorized Official - Phone: | 323-714-3560 |
Mailing Address - Street 1: | 401 N AVON ST |
Mailing Address - Street 2: | |
Mailing Address - City: | BURBANK |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 91505-3533 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 401 N AVON ST |
Practice Address - Street 2: | |
Practice Address - City: | BURBANK |
Practice Address - State: | CA |
Practice Address - Zip Code: | 91505-3533 |
Practice Address - Country: | US |
Practice Address - Phone: | 323-714-3560 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-05-26 |
Last Update Date: | 2023-05-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | 1679988372 | Other | NPI |