Provider Demographics
NPI:1790941144
Name:WEINTRAUB, LEE ANN SMITH (MPH, RD)
Entity Type:Individual
Prefix:
First Name:LEE ANN
Middle Name:SMITH
Last Name:WEINTRAUB
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:LEEANN
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH, RD
Mailing Address - Street 1:9696 CULVER BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2759
Mailing Address - Country:US
Mailing Address - Phone:310-562-4313
Mailing Address - Fax:310-427-7445
Practice Address - Street 1:9696 CULVER BLVD STE 301
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2759
Practice Address - Country:US
Practice Address - Phone:310-562-4313
Practice Address - Fax:310-427-7445
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133V00000X, 133VN1005X
CA922543133VN1005X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA922543OtherCDR