Provider Demographics
NPI:1528288214
Name:KUSHNER, LINDA AYELET (MS, RD, CDE)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:AYELET
Last Name:KUSHNER
Suffix:
Gender:F
Credentials:MS, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 NEWBURY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3452
Mailing Address - Country:US
Mailing Address - Phone:818-422-4499
Mailing Address - Fax:
Practice Address - Street 1:13652 CANTARA ST
Practice Address - Street 2:BALBOA PLAZA BLDG.
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-5423
Practice Address - Country:US
Practice Address - Phone:818-832-7235
Practice Address - Fax:818-832-7211
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA803804133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered