Active NPI
Tara Jensen, RD, IBCLC
- Registered Dietitian
- Los Angeles, CA
National Provider Identifier
1649050436
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86088492
- Practice address
- 3720 1/2 Corinth Ave
Los Angeles, CA 90066-3440 - Phone
- (310) 402-7611
- NPI assigned
- Sep 29, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Lactation Consultant (Non-RN) | 174N00000X | L-303509 | CA | |
| Registered Dietitian | 133V00000X | 86088492 | CA | Primary |
Addresses
Primary practice location
3720 1/2 Corinth Ave
Los Angeles, CA 90066-3440
Mailing address
3720 1/2 Corinth Ave
Los Angeles, CA 90066-3440
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 |
|---|---|---|---|
| 86088492 | CA | MD | Registered Dietitian |
| L-303509 | CA | MD | Lactation Consultant (Non-RN) |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1695945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695945600000",
"number": "1649050436",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3720 1/2 CORINTH AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900663440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3720 1/2 CORINTH AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900663440",
"telephone_number": "310-402-7611"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENSEN",
"first_name": "TARA",
"credential": "RD, IBCLC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-09-29",
"last_updated": "2023-09-29",
"certification_date": "2023-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "174N00000X",
"taxonomy_group": "",
"desc": "Lactation Consultant, Non-RN",
"state": "CA",
"license": "L-303509",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "86088492",
"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 Sep 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.