Provider Demographics
NPI:1104599075
Name:BLITSHTEYN, NAZANIN (RDN)
Entity type:Individual
Prefix:
First Name:NAZANIN
Middle Name:
Last Name:BLITSHTEYN
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 1:5224 ZELZAH AVE UNIT 102
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2164
Mailing Address - Country:US
Mailing Address - Phone:818-687-1725
Mailing Address - Fax:
Practice Address - Street 1:5224 ZELZAH AVE UNIT 102
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-2164
Practice Address - Country:US
Practice Address - Phone:818-687-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1068891133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered