Provider Demographics
NPI:1356679120
Name:BREITER, SHANI MARA (RD)
Entity Type:Individual
Prefix:MS
First Name:SHANI
Middle Name:MARA
Last Name:BREITER
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 1:4500 PARK GRANADA STE 202
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1666
Mailing Address - Country:US
Mailing Address - Phone:310-684-3610
Mailing Address - Fax:310-693-2502
Practice Address - Street 1:4500 PARK GRANADA STE 202
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1666
Practice Address - Country:US
Practice Address - Phone:310-684-3610
Practice Address - Fax:310-693-2502
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-06
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1012601133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered