Provider Demographics
NPI:1487461661
Name:DONIS, ELIZABETH YASMIN (MS, RD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:YASMIN
Last Name:DONIS
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 W 161ST ST
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4413
Mailing Address - Country:US
Mailing Address - Phone:424-376-7549
Mailing Address - Fax:
Practice Address - Street 1:1049 W 161ST ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4413
Practice Address - Country:US
Practice Address - Phone:424-376-7549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86070294133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered