Provider Demographics
NPI:1952709933
Name:ZWICKER, GERALDINE CORNELIA (RD CDE)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:CORNELIA
Last Name:ZWICKER
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:GERI
Other - Middle Name:CORNELIA
Other - Last Name:FILET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 NORTH STATE STREET
Mailing Address - Street 2:1 PT RM 2C2 115
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033
Mailing Address - Country:US
Mailing Address - Phone:323-409-6979
Mailing Address - Fax:323-441-8226
Practice Address - Street 1:2010 ZONAL AVENUE
Practice Address - Street 2:5E OPD
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-226-4556
Practice Address - Fax:323-226-8117
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
398572OtherCOMMISION ON DIETETIC REGISTRATION