Provider Demographics
NPI:1710475025
Name:FLANNIGAN, PHYLISS (RDN)
Entity Type:Individual
Prefix:
First Name:PHYLISS
Middle Name:
Last Name:FLANNIGAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27922 AVENIDA CUADERNO
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-1221
Mailing Address - Country:US
Mailing Address - Phone:310-483-3453
Mailing Address - Fax:
Practice Address - Street 1:27922 AVENIDA CUADERNO
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-1221
Practice Address - Country:US
Practice Address - Phone:310-483-3453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA713707133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered