Provider Demographics
NPI:1255700084
Name:DAVIJANI, LEYLA K
Entity type:Individual
Prefix:
First Name:LEYLA
Middle Name:K
Last Name:DAVIJANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEYLA
Other - Middle Name:K
Other - Last Name:DAVIJANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MHA, RD
Mailing Address - Street 1:26572 ROYALE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1412
Mailing Address - Country:US
Mailing Address - Phone:949-606-3573
Mailing Address - Fax:
Practice Address - Street 1:26572 ROYALE DR
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1412
Practice Address - Country:US
Practice Address - Phone:949-606-3573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA932113133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education