Provider Demographics
NPI:1366770067
Name:WILLIAMS, ELAINE G (PHD RD)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:G
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHD RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3834 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90062-1104
Mailing Address - Country:US
Mailing Address - Phone:323-730-1920
Mailing Address - Fax:323-730-1504
Practice Address - Street 1:3834 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062-1104
Practice Address - Country:US
Practice Address - Phone:323-730-1920
Practice Address - Fax:323-730-1504
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILR310826133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist