Provider Demographics
NPI:1356478861
Name:CHLA USC-UCEDD NUTRITION
Entity type:Organization
Organization Name:CHLA USC-UCEDD NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARION
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:BAER
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:323-669-2300
Mailing Address - Street 1:PO BOX 27980
Mailing Address - Street 2:3250 SUNSET BLVD.
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-0980
Mailing Address - Country:US
Mailing Address - Phone:323-669-2300
Mailing Address - Fax:323-844-8305
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:USC - UCEDD NUTRITION, M.S. #53
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-669-2300
Practice Address - Fax:323-844-8305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Single Specialty