Provider Demographics
NPI:1932482718
Name:BADA, NICOLLE LAURENE (RD)
Entity Type:Individual
Prefix:
First Name:NICOLLE
Middle Name:LAURENE
Last Name:BADA
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 1:1923 VELEZ DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-1423
Mailing Address - Country:US
Mailing Address - Phone:310-480-2525
Mailing Address - Fax:
Practice Address - Street 1:1923 VELEZ DR
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-1423
Practice Address - Country:US
Practice Address - Phone:310-480-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1000753133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered