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General NPI Number Information
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NPI Number | 1114468667
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Entity Type | Individual
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Provider Name | DINA BEN-NISSAN MS, RDN
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Gender | Female
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Dates
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Enumeration Date | 03/16/2017
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Last Update Date | 09/08/2017
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Provider Practice Location Address
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Address Line | 18372 CLARK ST STE 228
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City | TARZANA
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State | CA
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Zip | 91356-3555
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Country | US
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Telephone | 818-384-2886
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Fax |
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Provider Business Mailing Address
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Address Line | 18372 CLARK ST STE 228
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City | TARZANA
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State | CA
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Zip | 91356-3555
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 10182272
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86063099
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License Number State | CA
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