Provider Demographics
NPI:1982336103
Name:SAHEBGHALAM, NIKKI (RDN, CNS)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:SAHEBGHALAM
Suffix:
Gender:F
Credentials:RDN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 S BUNDY DR APT 403
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6187
Mailing Address - Country:US
Mailing Address - Phone:818-661-8292
Mailing Address - Fax:
Practice Address - Street 1:1420 S BUNDY DR APT 403
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6187
Practice Address - Country:US
Practice Address - Phone:818-661-8292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18350133N00000X
CA86299794133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist