Provider Demographics
NPI:1104389303
Name:BRAND, CHARLI ERICA (RDN)
Entity Type:Individual
Prefix:
First Name:CHARLI
Middle Name:ERICA
Last Name:BRAND
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2073 BACON ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-2537
Mailing Address - Country:US
Mailing Address - Phone:619-855-3980
Mailing Address - Fax:
Practice Address - Street 1:2073 BACON ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-2537
Practice Address - Country:US
Practice Address - Phone:619-855-3980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-13
Last Update Date:2019-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered