MEDICARE: ATHENA CAMERANESI RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86083006

General Provider Information

NPI Number	:	1134631229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATHENA CAMERANESI RDN

Provider Business Mailing Address
First Line	:	4331 BLACKWOOD ST
Second Line	:
City	:	NEWBURY PARK
State	:	CA
Zip	:	91320-4912
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 E HALEY ST STE E
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-2347
Country	:	US
Telephone Number	:	805-341-2893
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2017
Last Update Date	:	10/30/2017

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