Provider Demographics
NPI:1972713964
Name:PLACE, JILL (RD, CCN)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:
Last Name:PLACE
Suffix:
Gender:F
Credentials:RD, CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 MONTECITO DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-1449
Mailing Address - Country:US
Mailing Address - Phone:323-225-9850
Mailing Address - Fax:323-221-1395
Practice Address - Street 1:1309 MONTECITO DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-1449
Practice Address - Country:US
Practice Address - Phone:323-225-9850
Practice Address - Fax:323-221-1395
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00807328133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered