Provider Demographics
NPI:1477677425
Name:BAY AREA NUTRITION, LLC
Entity Type:Organization
Organization Name:BAY AREA NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO NUTR THERAPIST CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CEDRD-S
Authorized Official - Phone:408-370-7731
Mailing Address - Street 1:441 N CENTRAL AVE STE 2A
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-1428
Mailing Address - Country:US
Mailing Address - Phone:408-370-7731
Mailing Address - Fax:408-370-7732
Practice Address - Street 1:441 N CENTRAL AVE STE 2A
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1428
Practice Address - Country:US
Practice Address - Phone:408-370-7731
Practice Address - Fax:408-370-7732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24927ZOtherGROUP PRACTICE
CAZZZ28303ZMedicare ID - Type UnspecifiedGROUP PRACTICE