1083836308 NPI number — MRS. ELIZABETH ANN PARKS R.D.

Table of content: JANELLE SELLERS PHARM.D. (NPI 1962599449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083836308 NPI number — MRS. ELIZABETH ANN PARKS R.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKS
Provider First Name:
ELIZABETH
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083836308
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
765 W. COLLEGE ST.
Provider Second Line Business Mailing Address:
FOOD & NUTRITION SERVICES DEPT.
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90012-5923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-580-7298
Provider Business Mailing Address Fax Number:
213-580-7386

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
765 W. COLLEGE ST.
Provider Second Line Business Practice Location Address:
FOOD & NUTRITION SERVICES DEPT.
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90012-5923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-580-7298
Provider Business Practice Location Address Fax Number:
213-580-7386
Provider Enumeration Date:
05/03/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  R421467 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: R421467 . This is a "REGISTERED DIETITIAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".