Provider Demographics
NPI:1780444877
Name:BRENDA MORTARA
Entity type:Organization
Organization Name:BRENDA MORTARA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MORTARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-237-8486
Mailing Address - Street 1:85 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-5604
Mailing Address - Country:US
Mailing Address - Phone:775-237-8486
Mailing Address - Fax:
Practice Address - Street 1:85 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-5604
Practice Address - Country:US
Practice Address - Phone:775-237-8486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty