Healthcare Provider Details

I. General information

NPI: 1730719030
Provider Name (Legal Business Name): MEG WERNER MORETA MS, RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2020
Last Update Date: 01/25/2020
Certification Date: 01/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N ROBERTSON BLVD STE 210
BEVERLY HILLS CA
90211-2157
US

IV. Provider business mailing address

3251 PROVON LN
LOS ANGELES CA
90034-2714
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-3030
  • Fax:
Mailing address:
  • Phone: 310-486-2005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number721104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: