Provider Demographics
NPI:1457809394
Name:NEZAMI, MANIJEH (DR PH , RDN)
Entity Type:Individual
Prefix:DR
First Name:MANIJEH
Middle Name:
Last Name:NEZAMI
Suffix:
Gender:F
Credentials:DR PH , RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S BEDFORD ST
Mailing Address - Street 2:UNIT 103
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1895
Mailing Address - Country:US
Mailing Address - Phone:310-962-9308
Mailing Address - Fax:
Practice Address - Street 1:820 S BEDFORD ST
Practice Address - Street 2:UNIT 103
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1895
Practice Address - Country:US
Practice Address - Phone:310-962-9308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA897887133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered