Provider Demographics
NPI:1902177553
Name:SWEENEY, MALORIE BOTARDO (MS, RD, CEDS-S)
Entity Type:Individual
Prefix:
First Name:MALORIE
Middle Name:BOTARDO
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:MS, RD, CEDS-S
Other - Prefix:
Other - First Name:MALORIE
Other - Middle Name:BOTARDO
Other - Last Name:MESSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1862 ORINDA CT
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-1468
Mailing Address - Country:US
Mailing Address - Phone:786-514-2038
Mailing Address - Fax:
Practice Address - Street 1:1862 ORINDA CT
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-1468
Practice Address - Country:US
Practice Address - Phone:786-514-2038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86007012133V00000X
133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered