Provider Demographics
NPI:1871529792
Name:HIGGINS, PAMELA (RD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:HIGGINS
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 1:11301 WILSHIRE BLVD
Mailing Address - Street 2:BLDG 300 (120)
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90073-1003
Mailing Address - Country:US
Mailing Address - Phone:310-268-3916
Mailing Address - Fax:310-268-4787
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:BLDG 300 (120)
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-268-3916
Practice Address - Fax:310-268-4787
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered