Provider Demographics
NPI:1841744539
Name:GARRELL, MATTHEW (RD)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:GARRELL
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 LOUELLA AVE
Mailing Address - Street 2:2
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-5957
Mailing Address - Country:US
Mailing Address - Phone:914-489-6273
Mailing Address - Fax:
Practice Address - Street 1:2403 LOUELLA AVE
Practice Address - Street 2:2
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-5957
Practice Address - Country:US
Practice Address - Phone:914-489-6273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86027478133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered