Provider Demographics
NPI:1114182532
Name:BENDER, EMILY JULIETTE (NC, CHN)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JULIETTE
Last Name:BENDER
Suffix:
Gender:F
Credentials:NC, CHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BOLINAS RD
Mailing Address - Street 2:#A
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1678
Mailing Address - Country:US
Mailing Address - Phone:415-259-4471
Mailing Address - Fax:
Practice Address - Street 1:11 BOLINAS RD
Practice Address - Street 2:#A
Practice Address - City:FAIRFAX
Practice Address - State:CA
Practice Address - Zip Code:94930-1678
Practice Address - Country:US
Practice Address - Phone:415-259-4471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education