Provider Demographics
NPI:1619967544
Name:NOLAND, DIANA (RD MPH CCN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:NOLAND
Suffix:
Gender:F
Credentials:RD MPH CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 W BURBANK BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1348
Mailing Address - Country:US
Mailing Address - Phone:818-840-8098
Mailing Address - Fax:818-840-7042
Practice Address - Street 1:1834 W BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1348
Practice Address - Country:US
Practice Address - Phone:818-840-8098
Practice Address - Fax:818-840-7042
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
367490OtherREGISTERED DIETITIAN
CAMNT367490Medicare UPIN