Provider Demographics
NPI:1912207432
Name:LAVI, DANIELLA ROYA (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLA
Middle Name:ROYA
Last Name:LAVI
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 S CORNING ST UNIT 504
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2684
Mailing Address - Country:US
Mailing Address - Phone:310-801-9451
Mailing Address - Fax:
Practice Address - Street 1:1260 S CORNING ST UNIT 504
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2684
Practice Address - Country:US
Practice Address - Phone:310-801-9451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01017100133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered