Provider Demographics
NPI:1336543479
Name:BRATO, JODIE (RD)
Entity Type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:
Last Name:BRATO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18601 COLLINS ST APT D22
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2159
Mailing Address - Country:US
Mailing Address - Phone:818-383-4595
Mailing Address - Fax:
Practice Address - Street 1:18601 COLLINS ST APT D22
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2159
Practice Address - Country:US
Practice Address - Phone:818-383-4595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86021335133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered