Basic Information
Provider Information | |||||||||
NPI: | 1982849436 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GHAFFARI | ||||||||
FirstName: | ERIN | ||||||||
MiddleName: | NICOLE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | RD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ANDREWS | ||||||||
OtherFirstName: | ERIN | ||||||||
OtherMiddleName: | NICOLE | ||||||||
OtherNamePrefix: | MRS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | RD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 940838 | ||||||||
Address2: |   | ||||||||
City: | SIMI VALLEY | ||||||||
State: | CA | ||||||||
PostalCode: | 930940838 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8054337507 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2438 N PONDEROSA DR | ||||||||
Address2: | UNIT C-101 | ||||||||
City: | CAMARILLO | ||||||||
State: | CA | ||||||||
PostalCode: | 930102369 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8053839727 | ||||||||
FaxNumber: | 8057640176 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/12/2008 | ||||||||
LastUpdateDate: | 05/17/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133VN1005X | 893617 | IL | Y |   | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Renal |
No ID Information.