Basic Information
Provider Information
NPI: 1003140138
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAHMON
FirstName: FABIANA
MiddleName: C
NamePrefix: MRS.
NameSuffix:  
Credential: RD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1634 HAVEMEYER LN
Address2:  
City: REDONDO BEACH
State: CA
PostalCode: 902784715
CountryCode: US
TelephoneNumber: 3106958033
FaxNumber:  
Practice Location
Address1: 1515 N VERMONT AVE
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900275337
CountryCode: US
TelephoneNumber: 3237837011
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/22/2009
LastUpdateDate: 10/24/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
133V00000X01010197CAY Dietary & Nutritional Service ProvidersDietitian, Registered 

No ID Information.


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