Provider Demographics
NPI:1316124068
Name:PERKOV, ANDREA M (RD)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:M
Last Name:PERKOV
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 1:23133 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3729
Mailing Address - Country:US
Mailing Address - Phone:310-378-3456
Mailing Address - Fax:310-373-3190
Practice Address - Street 1:23133 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3729
Practice Address - Country:US
Practice Address - Phone:310-378-3456
Practice Address - Fax:310-373-3190
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA837464133V00000X, 133VN1005X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic