Provider Demographics
NPI:1861017303
Name:SCM NUTRITION AND DIET INC
Entity Type:Organization
Organization Name:SCM NUTRITION AND DIET INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:MIZARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-522-9851
Mailing Address - Street 1:2155 VERDUGO BLVD STE 406
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1628
Mailing Address - Country:US
Mailing Address - Phone:818-522-9851
Mailing Address - Fax:
Practice Address - Street 1:2437 BYWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206
Practice Address - Country:US
Practice Address - Phone:818-522-9851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty