Provider Demographics
NPI:1063875268
Name:DITTMAN, CARSAN (RDN)
Entity type:Individual
Prefix:
First Name:CARSAN
Middle Name:
Last Name:DITTMAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5117 MACAFEE RD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4332
Mailing Address - Country:US
Mailing Address - Phone:310-947-2318
Mailing Address - Fax:
Practice Address - Street 1:507 PIER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-3822
Practice Address - Country:US
Practice Address - Phone:310-372-7234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86063718133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered