Provider Demographics
NPI:1528578010
Name:HERMAN MENDES, DENA R (PHD, MPH, RD)
Entity Type:Individual
Prefix:DR
First Name:DENA
Middle Name:R
Last Name:HERMAN MENDES
Suffix:
Gender:F
Credentials:PHD, MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 VIA DE LA PAZ
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-4631
Mailing Address - Country:US
Mailing Address - Phone:310-968-1242
Mailing Address - Fax:
Practice Address - Street 1:UCLA
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-968-1242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA859684133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA859684OtherRD LICENSE - ACADEMY OF NUTRITION AND DIETETICS