Provider Demographics
NPI:1982489233
Name:MURRAY, JESSICA RAE (RD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:MURRAY
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 1:4216 FOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-2256
Mailing Address - Country:US
Mailing Address - Phone:323-644-3880
Mailing Address - Fax:323-660-0935
Practice Address - Street 1:1530 HILLHURST AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5516
Practice Address - Country:US
Practice Address - Phone:323-644-3880
Practice Address - Fax:323-660-0935
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered