Active NPI
Mildred K Leatham, MPH, RD, CHES
- Registered Dietitian
- Los Angeles, CA
National Provider Identifier
1174763833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 964557
- Practice address
- 4650 Sunset Blvd. Ms#115
Los Angeles, CA 90027 - Phone
- (323) 361-3815
- NPI assigned
- Feb 20, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 964557 | NC | Primary |
Addresses
Primary practice location
4650 Sunset Blvd. Ms#115
Los Angeles, CA 90027
Mailing address
3250 Wilshire Boulvard
Los Angeles, CA 90010
Phone (323) 361-3815
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 964557 | NC | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235088000000",
"number": "1174763833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3250 WILSHIRE BOULVARD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90010",
"telephone_number": "323-361-3815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4650 SUNSET BLVD. MS#115",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90027",
"telephone_number": "323-361-3815"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEATHAM",
"first_name": "MILDRED",
"middle_name": "K",
"name_prefix": "Ms.",
"credential": "MPH, RD, CHES",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-02-20",
"last_updated": "2009-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NC",
"license": "964557",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.