Provider Demographics
NPI:1609583871
Name:LAVINE, NAVA MATANYA (RD, CD)
Entity type:Individual
Prefix:
First Name:NAVA
Middle Name:MATANYA
Last Name:LAVINE
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 BAGLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-4111
Mailing Address - Country:US
Mailing Address - Phone:310-817-1347
Mailing Address - Fax:
Practice Address - Street 1:1812 BAGLEY AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-4111
Practice Address - Country:US
Practice Address - Phone:310-817-1347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
WA61336411133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered