Provider Demographics
NPI:1447921903
Name:MESICK, DUSTIN (RD)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:MESICK
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7870 BLERIOT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-2905
Mailing Address - Country:US
Mailing Address - Phone:310-780-8647
Mailing Address - Fax:
Practice Address - Street 1:7870 BLERIOT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-2905
Practice Address - Country:US
Practice Address - Phone:310-780-8647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2022-08-18
Deactivation Date:2022-07-18
Deactivation Code:
Reactivation Date:2022-08-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered