Basic Information
| Provider Information | |||||||||
| NPI: | 1295763464 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAYEDA | ||||||||
| FirstName: | SUSAN | ||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 ROCKEFELLER LN | ||||||||
| Address2: | #3 | ||||||||
| City: | REDONDO BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902783544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106737288 | ||||||||
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| Practice Location | |||||||||
| Address1: | 555 E HARDY ST | ||||||||
| Address2: | |||||||||
| City: | INGLEWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 903014011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106734660 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.