Most Relevant Information
Provider Data
| NPI Number: | 1003033531 |
| Provider Name: | MARY-JEANNE DER AVEDISSIAN M.S., R.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 133V00000X |
| Specialty: | Dietitian, Registered |
| License Number: | 590756 |
Most Important Dates
| Enumeration Date: | 04/19/2007 |
| Last Updated: | 06/18/2013 |
Provider Practice Location
626 MYRTLE ST
GLENDALE
CA
912031612
Practice Location Phone/Fax
| Phone: | 8182404328 |
| Fax: |
Provider Mailing Location
626 MYRTLE ST
GLENDALE
CA
912031612
Provider Mailing Phone/Fax
| Phone: | 8182404328 |
| Fax: |