Provider Demographics
NPI:1285382804
Name:CAMPBELL, VALORIE ANN (RD)
Entity type:Individual
Prefix:
First Name:VALORIE
Middle Name:ANN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18008 BURBANK BLVD APT 3
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1627
Mailing Address - Country:US
Mailing Address - Phone:323-309-9862
Mailing Address - Fax:
Practice Address - Street 1:18008 BURBANK BLVD APT 3
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1627
Practice Address - Country:US
Practice Address - Phone:323-309-9862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86026715133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered