Provider Demographics
NPI:1952913519
Name:PREISENDORF, DAWN MARIE (MA)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:PREISENDORF
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 TELEGRAPH AVE STE 131
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2054
Mailing Address - Country:US
Mailing Address - Phone:510-457-1182
Mailing Address - Fax:
Practice Address - Street 1:3031 TELEGRAPH AVE STE 131
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2054
Practice Address - Country:US
Practice Address - Phone:510-457-1182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist