Basic Information
Provider Information
NPI: 1003295247
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SALVESTRINI
FirstName: AMANDA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MS, RD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11301 WILSHIRE BLVD
Address2: BUILDING 213. 3RD FLOOR. ROOM 317.
City: LOS ANGELES
State: CA
PostalCode: 900731003
CountryCode: US
TelephoneNumber: 3104783711
FaxNumber:  
Practice Location
Address1: 11301 WILSHIRE BLVD
Address2: BUILDING 213. 3RD FLOOR. ROOM 317.
City: LOS ANGELES
State: CA
PostalCode: 900731003
CountryCode: US
TelephoneNumber: 3104783711
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/20/2015
LastUpdateDate: 05/20/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
133V00000X86003169CAY Dietary & Nutritional Service ProvidersDietitian, Registered 

No ID Information.


Home