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Individual

DIANA K SHORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
18546 ROSCOE BLVD, SUITE 230, NORTHRIDGE, CA 91324-4663
(818) 886-1100
(818) 886-7501
Mailing address
18546 ROSCOE BLVD, SUITE 230, NORTHRIDGE, CA 91324-4663
(818) 886-1100
(818) 886-7501

Taxonomy

Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
557560
CA
133V00000X
Registered Dietitian
557560
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
557560
STATE LICENSE
CA
Enumeration date
07/08/2006
Last updated
09/11/2025
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