Provider Demographics
NPI:1689273369
Name:AZIZZADEH, DAVINA (RD)
Entity Type:Individual
Prefix:MRS
First Name:DAVINA
Middle Name:
Last Name:AZIZZADEH
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 1:121 N OAKHURST DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5504
Mailing Address - Country:US
Mailing Address - Phone:310-892-3531
Mailing Address - Fax:
Practice Address - Street 1:121 N OAKHURST DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5504
Practice Address - Country:US
Practice Address - Phone:310-892-3531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA955103133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered