Provider Demographics
NPI:1124457577
Name:MALAMUD, SUZANNE (MS, RD)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:MALAMUD
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5460 WHITE OAK AVE UNIT F303
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2413
Mailing Address - Country:US
Mailing Address - Phone:818-282-4771
Mailing Address - Fax:818-530-7791
Practice Address - Street 1:5460 WHITE OAK AVE UNIT F303
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-2413
Practice Address - Country:US
Practice Address - Phone:818-282-4771
Practice Address - Fax:818-530-7791
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA994288133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered