Provider Demographics
NPI:1861960569
Name:KRAM, DORA RACHEL (RD)
Entity type:Individual
Prefix:
First Name:DORA
Middle Name:RACHEL
Last Name:KRAM
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EASTFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90274-5226
Mailing Address - Country:US
Mailing Address - Phone:310-251-8674
Mailing Address - Fax:
Practice Address - Street 1:2 EASTFIELD DR
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS
Practice Address - State:CA
Practice Address - Zip Code:90274-5226
Practice Address - Country:US
Practice Address - Phone:310-251-8674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86087338133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered