Provider Demographics
NPI:1790287860
Name:ROTHENBERG, TAMAR SOFER (RDN)
Entity Type:Individual
Prefix:MRS
First Name:TAMAR
Middle Name:SOFER
Last Name:ROTHENBERG
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 S CREST DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3314
Mailing Address - Country:US
Mailing Address - Phone:310-277-3579
Mailing Address - Fax:
Practice Address - Street 1:1526 S CREST DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-3314
Practice Address - Country:US
Practice Address - Phone:310-277-3579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86028995133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered