Provider Demographics
NPI:1447052113
Name:EKRAMZADEH, MARYAM (PHD, RDN)
Entity type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:
Last Name:EKRAMZADEH
Suffix:
Gender:
Credentials:PHD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 W 190TH ST APT 128
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1060
Mailing Address - Country:US
Mailing Address - Phone:310-750-8169
Mailing Address - Fax:
Practice Address - Street 1:5530 W 190TH ST APT 128
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1060
Practice Address - Country:US
Practice Address - Phone:310-750-8169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86393410133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered