Provider Demographics
NPI:1194758664
Name:SHORE, DIANA K
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:K
Last Name:SHORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:K
Other - Last Name:RINARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD RD
Mailing Address - Street 1:18546 ROSCOE BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4663
Mailing Address - Country:US
Mailing Address - Phone:818-886-1100
Mailing Address - Fax:818-886-7501
Practice Address - Street 1:18546 ROSCOE BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4663
Practice Address - Country:US
Practice Address - Phone:818-886-1100
Practice Address - Fax:818-886-7501
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA557560133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA557560OtherSTATE LICENSE