Provider Demographics
NPI:1942717384
Name:BADER, DIMA (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:MISS
First Name:DIMA
Middle Name:
Last Name:BADER
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28403 FALCON CREST DR
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-5019
Mailing Address - Country:US
Mailing Address - Phone:661-476-4243
Mailing Address - Fax:
Practice Address - Street 1:858 W JACKMAN ST STE 101
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2488
Practice Address - Country:US
Practice Address - Phone:661-948-1228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86015095133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA86015095OtherCOMMISSION ON DIETETIC REGISTRATION (CDR)