Provider Demographics
NPI:1124326855
Name:FERGUSON MAHARAJ, NICOLE (MS, RD, CDE)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:FERGUSON MAHARAJ
Suffix:
Gender:F
Credentials:MS, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12518 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-1518
Mailing Address - Country:US
Mailing Address - Phone:310-795-9391
Mailing Address - Fax:310-306-4847
Practice Address - Street 1:12518 ROSE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-1518
Practice Address - Country:US
Practice Address - Phone:310-795-9391
Practice Address - Fax:310-306-4847
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric