Provider Demographics
NPI:1861795791
Name:MILTON, ANDREA LEE (RD, CDE)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEE
Last Name:MILTON
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7722 CAPISTRANO AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91304-5404
Mailing Address - Country:US
Mailing Address - Phone:818-317-5636
Mailing Address - Fax:818-912-6516
Practice Address - Street 1:7722 CAPISTRANO AVE
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91304-5404
Practice Address - Country:US
Practice Address - Phone:818-317-5636
Practice Address - Fax:818-912-6516
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA859147133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered