Provider Demographics
NPI:1003574781
Name:BERNARD, DOROTHY (MS, RDN, IFNCP)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:BERNARD
Suffix:
Gender:F
Credentials:MS, RDN, IFNCP
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:
Other - Last Name:BERNET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RDN, CPT
Mailing Address - Street 1:1041 PRINCETON ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1041 PRINCETON ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4701
Practice Address - Country:US
Practice Address - Phone:310-828-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00865470133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered