Provider Demographics
NPI:1538199948
Name:GENTILE, KRISTIEN ELYSE (RD)
Entity type:Individual
Prefix:
First Name:KRISTIEN
Middle Name:ELYSE
Last Name:GENTILE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:ELYSE
Other - Last Name:GENTILE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2512 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2147
Mailing Address - Country:US
Mailing Address - Phone:310-849-3109
Mailing Address - Fax:
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA957101133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered