Active NPI
Mary Louise Lane-Carlson, EDD, MPH, RD, CDE
- Registered Dietitian
- La Mirada, CA
National Provider Identifier
1508119140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- R615454
- Practice address
- 16132 Crestline Dr
La Mirada, CA 90638-3458 - Phone
- (562) 947-5860
- NPI assigned
- Oct 19, 2012
- Sex
- Female
- Sole proprietor
- Yes
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 | R615454 | CA | Primary |
Addresses
Primary practice location
16132 Crestline Dr
La Mirada, CA 90638-3458
Mailing address
16132 Crestline Dr
La Mirada, CA 90638-3458
Phone (562) 947-5860
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 |
|---|---|---|---|
| R615454 | CA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350604800000",
"number": "1508119140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16132 CRESTLINE DR",
"city": "LA MIRADA",
"state": "CA",
"postal_code": "906383458",
"telephone_number": "562-947-5860"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16132 CRESTLINE DR",
"city": "LA MIRADA",
"state": "CA",
"postal_code": "906383458",
"telephone_number": "562-947-5860"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANE-CARLSON",
"first_name": "MARY",
"middle_name": "LOUISE",
"name_prefix": "Dr.",
"credential": "EDD, MPH, RD, CDE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-10-19",
"last_updated": "2012-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "R615454",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Mirada, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.