Provider Demographics
NPI:1780378786
Name:CARRICO, LOLITA (CN)
Entity type:Individual
Prefix:
First Name:LOLITA
Middle Name:
Last Name:CARRICO
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 MAIN ST UNIT 515
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2245
Mailing Address - Country:US
Mailing Address - Phone:323-685-6663
Mailing Address - Fax:
Practice Address - Street 1:2219 MAIN ST UNIT 515
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-2245
Practice Address - Country:US
Practice Address - Phone:323-685-6663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education