Provider Demographics
NPI:1144699737
Name:SILVERMAN, MELANIE R (MS, RD, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:R
Last Name:SILVERMAN
Suffix:
Gender:F
Credentials:MS, RD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 ALTA LAGUNA BLVD
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2064
Mailing Address - Country:US
Mailing Address - Phone:949-607-8248
Mailing Address - Fax:949-272-2365
Practice Address - Street 1:3060 ALTA LAGUNA BLVD
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2064
Practice Address - Country:US
Practice Address - Phone:949-607-8248
Practice Address - Fax:949-272-2365
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA836825133V00000X
CAL-32076174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN