Provider Demographics
NPI:1851677744
Name:MORRELL, KRISTY (RD)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:MORRELL
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 1:11740 MONTANA AVE APT 404
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6749
Mailing Address - Country:US
Mailing Address - Phone:310-435-9380
Mailing Address - Fax:
Practice Address - Street 1:11740 MONTANA AVE APT 404
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6749
Practice Address - Country:US
Practice Address - Phone:310-435-9380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA924869133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered