MEDICARE: MISS DIMA BADER REGISTERED DIETITIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133NN1002X	Nutrition Education Nutritionist	86015095	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	86015095	OTHER	CA	COMMISSION ON DIETETIC REGISTRATION (CDR)

General Provider Information

NPI Number	:	1942717384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DIMA BADER REGISTERED DIETITIAN

Provider Business Mailing Address
First Line	:	28403 FALCON CREST DR
Second Line	:
City	:	CANYON COUNTRY
State	:	CA
Zip	:	91351-5019
Country	:	US
Telephone Number	:	661-476-4243
Fax Number	:

Provider Business Practice Location Address
First Line	:	858 W JACKMAN ST STE 101
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-2488
Country	:	US
Telephone Number	:	661-948-1228
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2018
Last Update Date	:	06/16/2018

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