Provider Demographics
NPI:1720974926
Name:HILLSTROM, KATHRYN AMANDA (EDD,MPH,RDN)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:AMANDA
Last Name:HILLSTROM
Suffix:
Gender:F
Credentials:EDD,MPH,RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26315 REGENT AVE
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-3517
Mailing Address - Country:US
Mailing Address - Phone:310-612-2075
Mailing Address - Fax:
Practice Address - Street 1:26315 REGENT AVE
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-3517
Practice Address - Country:US
Practice Address - Phone:310-612-2075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA859656133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered