Provider Demographics
NPI:1134252935
Name:SHETH, VANDANA RAJAN (RD)
Entity type:Individual
Prefix:
First Name:VANDANA
Middle Name:RAJAN
Last Name:SHETH
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 1:26958 BASSWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-2272
Mailing Address - Country:US
Mailing Address - Phone:310-408-8766
Mailing Address - Fax:310-378-5798
Practice Address - Street 1:23133 HAWTHORNE BLVD
Practice Address - Street 2:STE 104
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3729
Practice Address - Country:US
Practice Address - Phone:310-408-8766
Practice Address - Fax:855-415-8967
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA832841133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NT832841OtherPROVIDER TRANSACTION ACCESS NUMBER (PTAN)