Provider Demographics
NPI:1477052983
Name:BERGER, CARISSA (RDN)
Entity Type:Individual
Prefix:MS
First Name:CARISSA
Middle Name:
Last Name:BERGER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:MS
Other - First Name:CASSIE
Other - Middle Name:
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN
Mailing Address - Street 1:16010 TUPPER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-3046
Mailing Address - Country:US
Mailing Address - Phone:310-623-2687
Mailing Address - Fax:
Practice Address - Street 1:16010 TUPPER ST
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-3046
Practice Address - Country:US
Practice Address - Phone:310-623-2687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-10
Last Update Date:2018-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86059239133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered