Provider Demographics
NPI:1083971402
Name:BRIGHT, LARI (MS, RD)
Entity Type:Individual
Prefix:
First Name:LARI
Middle Name:
Last Name:BRIGHT
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:LARI
Other - Middle Name:L
Other - Last Name:BRIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RD
Mailing Address - Street 1:28737 CONEJO VIEW DR
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-3376
Mailing Address - Country:US
Mailing Address - Phone:818-317-1004
Mailing Address - Fax:
Practice Address - Street 1:28737 CONEJO VIEW DR
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-3376
Practice Address - Country:US
Practice Address - Phone:818-317-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1027035133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered