Provider Demographics
NPI:1811306699
Name:LOWE, JESSICA (MPH, RD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LOWE
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 ZONAL AVE
Mailing Address - Street 2:OPD 3P61
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1026
Mailing Address - Country:US
Mailing Address - Phone:323-226-8444
Mailing Address - Fax:323-226-7304
Practice Address - Street 1:2010 ZONAL AVE
Practice Address - Street 2:OPD 3P61
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1026
Practice Address - Country:US
Practice Address - Phone:323-226-8444
Practice Address - Fax:323-226-7304
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
999480133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered