Provider Demographics
NPI:1346378627
Name:BREMEN, MYRA KAY (RDN, ATC)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:KAY
Last Name:BREMEN
Suffix:
Gender:F
Credentials:RDN, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1826 W CHATEAU AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-4506
Mailing Address - Country:US
Mailing Address - Phone:650-283-0075
Mailing Address - Fax:
Practice Address - Street 1:1826 W CHATEAU AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-4506
Practice Address - Country:US
Practice Address - Phone:650-283-0075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
CA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer