Provider Demographics
NPI:1699032441
Name:MALEKI, MARYAM (MS, RD)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:MALEKI
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9165 ALCOTT ST
Mailing Address - Street 2:APT 203
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3263
Mailing Address - Country:US
Mailing Address - Phone:310-497-3097
Mailing Address - Fax:
Practice Address - Street 1:9165 ALCOTT ST
Practice Address - Street 2:APT 203
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-3263
Practice Address - Country:US
Practice Address - Phone:310-497-3097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA954685133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered