Provider Demographics
NPI:1619733235
Name:NOURI-MAHDAVI, AVA (RD)
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:
Last Name:NOURI-MAHDAVI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24632 PARK GRANADA
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1411
Mailing Address - Country:US
Mailing Address - Phone:818-442-3900
Mailing Address - Fax:
Practice Address - Street 1:24632 PARK GRANADA
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1411
Practice Address - Country:US
Practice Address - Phone:818-442-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered