Healthcare Provider Details

I. General information

NPI: 1952248411
Provider Name (Legal Business Name): MARY LOUISE ZERNICKE RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 OAKVALE AVE
BERKELEY CA
94705-2404
US

IV. Provider business mailing address

8 OAKVALE AVE
BERKELEY CA
94705-2404
US

V. Phone/Fax

Practice location:
  • Phone: 510-798-7333
  • Fax:
Mailing address:
  • Phone: 510-798-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1101X
TaxonomyGerontological Nutrition Registered Dietitian
License Number479896
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: