Provider Demographics
NPI:1902826555
Name:SHIELDS-JONES, ESTHER MONTGOMERY (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:MRS
First Name:ESTHER
Middle Name:MONTGOMERY
Last Name:SHIELDS-JONES
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:MRS
Other - First Name:ESTHER
Other - Middle Name:MONTGOMERY
Other - Last Name:SHIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED DIETITIAN
Mailing Address - Street 1:4581 DON FELIPE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-2853
Mailing Address - Country:US
Mailing Address - Phone:323-299-9026
Mailing Address - Fax:323-296-5827
Practice Address - Street 1:1251 W. REDONDO BEACH BLVD
Practice Address - Street 2:GARDENA COMMUNITY BASE OUTPATIENT CLINIC
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247
Practice Address - Country:US
Practice Address - Phone:310-851-4705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL408133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered