Provider Demographics
NPI:1720226038
Name:MAUDLIN, DONNA ANN (RD)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:ANN
Last Name:MAUDLIN
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 1:3630 E IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-2636
Mailing Address - Country:US
Mailing Address - Phone:310-900-8474
Mailing Address - Fax:310-900-8877
Practice Address - Street 1:3630 E IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2636
Practice Address - Country:US
Practice Address - Phone:310-900-8474
Practice Address - Fax:310-900-8877
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered