Provider Demographics
NPI:1881763472
Name:BAUERSFELD, ELLEN THOMSON (RD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:THOMSON
Last Name:BAUERSFELD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18372 CLARK ST
Mailing Address - Street 2:SUITE 226
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3508
Mailing Address - Country:US
Mailing Address - Phone:818-881-9192
Mailing Address - Fax:818-881-0261
Practice Address - Street 1:18372 CLARK ST
Practice Address - Street 2:SUITE 226
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3508
Practice Address - Country:US
Practice Address - Phone:818-881-9192
Practice Address - Fax:818-881-0261
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered