Provider Demographics
NPI:1417778168
Name:VALENCIA GRANILLO, ELIZABETH (RDN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:VALENCIA GRANILLO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6214 ST ALBANS ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-1320
Mailing Address - Country:US
Mailing Address - Phone:408-990-6446
Mailing Address - Fax:
Practice Address - Street 1:801 W VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-3250
Practice Address - Country:US
Practice Address - Phone:626-283-5128
Practice Address - Fax:888-851-3688
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered