Provider Demographics
NPI:1629265335
Name:SHIMADA, LORAINE SUE (RD)
Entity Type:Individual
Prefix:
First Name:LORAINE
Middle Name:SUE
Last Name:SHIMADA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:LORAINE
Other - Middle Name:SUE
Other - Last Name:ICHINAGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:4644 LINCOLN BLVD
Mailing Address - Street 2:SUITE 409
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6313
Mailing Address - Country:US
Mailing Address - Phone:310-578-6747
Mailing Address - Fax:310-578-6750
Practice Address - Street 1:4644 LINCOLN BLVD
Practice Address - Street 2:SUITE 409
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6313
Practice Address - Country:US
Practice Address - Phone:310-578-6747
Practice Address - Fax:310-578-6750
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered