Active NPI
Estrellita Andal Hermogeno, R.D.
- Registered Dietitian
- Los Angeles, CA
National Provider Identifier
1528284619
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 407875
- Practice address
- 765 W College St
Los Angeles, CA 90012-1181 - Phone
- (213) 580-7299
- NPI assigned
- Apr 17, 2007
- Last updated
- Jul 8, 2007
- 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 | 407875 | CA | Primary |
Addresses
Primary practice location
765 W College St
Los Angeles, CA 90012-1181
Mailing address
13698 Balboa CT
Fontana, CA 92336-3401
Phone (909) 899-7502
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 |
|---|---|---|---|
| 407875 | CA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1528284619",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13698 BALBOA CT",
"city": "FONTANA",
"state": "CA",
"postal_code": "923363401",
"telephone_number": "909-899-7502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "765 W COLLEGE ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900121181",
"telephone_number": "213-580-7299"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERMOGENO",
"first_name": "ESTRELLITA",
"middle_name": "ANDAL",
"credential": "R.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "407875",
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.