Healthcare Provider Details

I. General information

NPI: 1316752249
Provider Name (Legal Business Name): BRANDI CLOUET RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 RUTAN RD
SCENERY HILL PA
15360-8518
US

IV. Provider business mailing address

45 RUTAN RD
SCENERY HILL PA
15360-8518
US

V. Phone/Fax

Practice location:
  • Phone: 951-236-6232
  • Fax:
Mailing address:
  • Phone: 951-236-6232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number5535
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: