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General NPI Number Information
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NPI Number | 1942717384
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Entity Type | Individual
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Provider Name | DIMA BADER REGISTERED DIETITIAN
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Gender | Female
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Dates
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Enumeration Date | 01/08/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 858 W JACKMAN ST STE 101
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City | LANCASTER
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State | CA
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Zip | 93534-2488
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Country | US
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Telephone | 661-948-1228
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Fax |
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Provider Business Mailing Address
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Address Line | 28403 FALCON CREST DR
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City | CANYON COUNTRY
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State | CA
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Zip | 91351-5019
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Country | US
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Telephone | 661-476-4243
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | 86015095
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License Number State | CA
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