Provider Demographics
NPI:1255084810
Name:DD HIZZLE LLC
Entity type:Organization
Organization Name:DD HIZZLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:MALSACK
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:949-371-6947
Mailing Address - Street 1:25 PALATINE APT 451
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-7627
Mailing Address - Country:US
Mailing Address - Phone:310-993-1197
Mailing Address - Fax:
Practice Address - Street 1:25 PALATINE APT 451
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-7627
Practice Address - Country:US
Practice Address - Phone:310-993-1197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Single Specialty
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports DieteticsGroup - Single Specialty