Provider Demographics
NPI:1285039537
Name:MAR, ANTONETTE (MS, RD, CNSC)
Entity Type:Individual
Prefix:MRS
First Name:ANTONETTE
Middle Name:
Last Name:MAR
Suffix:
Gender:F
Credentials:MS, RD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12512 MONTBATTEN PL
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-6773
Mailing Address - Country:US
Mailing Address - Phone:661-586-4088
Mailing Address - Fax:
Practice Address - Street 1:12512 MONTBATTEN PL
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-6773
Practice Address - Country:US
Practice Address - Phone:661-586-4088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA988860133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered