Individual
BRANDI NICOLE NICHOLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDN, IBCLC
Contact information
Practice address
756 W 108TH ST, LOS ANGELES, CA 90044-4345
(310) 872-7426
Mailing address
756 W 108TH ST, LOS ANGELES, CA 90044-4345
(310) 872-7426
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1012432
CA
174N00000X
Lactation Consultant (Non-RN)
L-301756
CA
Other
Enumeration date
04/21/2016
Last updated
05/17/2023
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