Provider Demographics
NPI:1275155079
Name:ROTENBERG, EMILY V (RDN)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:V
Last Name:ROTENBERG
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:PO BOX 5185
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-9669
Mailing Address - Country:US
Mailing Address - Phone:310-569-9971
Mailing Address - Fax:
Practice Address - Street 1:3929 UNITED RD
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-3632
Practice Address - Country:US
Practice Address - Phone:747-334-2418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86079305133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered