Healthcare Provider Details

I. General information

NPI: 1487701603
Provider Name (Legal Business Name): JOYCE BARBARA BERENSON R.D., C.D.E.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45740 PALMETTO WAY
TEMECULA CA
92592-6059
US

IV. Provider business mailing address

45740 PALMETTO WAY
TEMECULA CA
92592
US

V. Phone/Fax

Practice location:
  • Phone: 951-676-0285
  • Fax: 951-676-3225
Mailing address:
  • Phone: 951-676-0285
  • Fax: 844-249-5571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number832911
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: