Healthcare Provider Details

I. General information

NPI: 1417434366
Provider Name (Legal Business Name): DANIELLE ALESSANDRA BUBLITZ RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9449 SAN FERNANDO RD
SUN VALLEY CA
91352-1421
US

IV. Provider business mailing address

2605 W KELLY RD
NEWBURY PARK CA
91320-3802
US

V. Phone/Fax

Practice location:
  • Phone: 818-767-3310
  • Fax:
Mailing address:
  • Phone: 530-774-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86059367
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: