Provider Demographics
NPI:1346094141
Name:PETERSON, BRIDGET (RD)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21008 COUNTRY PARK RD
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93908-1400
Mailing Address - Country:US
Mailing Address - Phone:831-261-1031
Mailing Address - Fax:
Practice Address - Street 1:21008 COUNTRY PARK RD
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93908-1400
Practice Address - Country:US
Practice Address - Phone:831-261-1031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered