Provider Demographics
NPI:1750629234
Name:MAHALLATI, MARJAN (RHN,NC)
Entity Type:Individual
Prefix:MRS
First Name:MARJAN
Middle Name:
Last Name:MAHALLATI
Suffix:
Gender:F
Credentials:RHN,NC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9403 SPECTRUM
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3422
Mailing Address - Country:US
Mailing Address - Phone:949-887-6586
Mailing Address - Fax:
Practice Address - Street 1:113 WATERWORKS WAY, SUITE 340
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3422
Practice Address - Country:US
Practice Address - Phone:949-887-6586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist