Healthcare Provider Details

I. General information

NPI: 1174647713
Provider Name (Legal Business Name): BEN PETER BRATCHER RD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BENJAMIN PETER BRATCHER RD

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 ROSECRANS AVE
BELLFLOWER CA
90706-2246
US

IV. Provider business mailing address

17296 SLOVER AVE
FONTANA CA
92337-7585
US

V. Phone/Fax

Practice location:
  • Phone: 562-461-4339
  • Fax:
Mailing address:
  • Phone: 909-609-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000961736
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: