Provider Demographics
NPI:1144557612
Name:WEST, PAULA ANN (RD, LD)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:ANN
Last Name:WEST
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CEDAR SE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106
Mailing Address - Country:US
Mailing Address - Phone:505-239-3906
Mailing Address - Fax:505-792-6956
Practice Address - Street 1:201 CEDAR SE
Practice Address - Street 2:SUITE 505
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106
Practice Address - Country:US
Practice Address - Phone:505-353-5226
Practice Address - Fax:505-792-6956
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD-0755133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered