Provider Demographics
NPI:1497050769
Name:STEINHARDT, MYRA PERRY (RD)
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:PERRY
Last Name:STEINHARDT
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 1:3259 CAMINO CORONADO
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-9312
Mailing Address - Country:US
Mailing Address - Phone:760-271-3629
Mailing Address - Fax:760-632-0971
Practice Address - Street 1:7760 EL CAMINO REAL STE A
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-8553
Practice Address - Country:US
Practice Address - Phone:760-271-3629
Practice Address - Fax:760-632-0971
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
473026133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered