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NPI Code Detail

MEDICARE: MS. SHANI MARA BREITER RD

MEDICARE: MS. SHANI MARA BREITER RD
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
1133V00000XRegistered Dietitian1012601CA

General Provider Information

NPI Number : 1356679120
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHANI MARA BREITER RD
Provider Business Mailing Address
First Line : 4500 PARK GRANADA STE 202
Second Line :
City : CALABASAS
State : CA
Zip : 91302-1666
Country : US
Telephone Number : 310-684-3610
Fax Number : 310-693-2502
Provider Business Practice Location Address
First Line : 4500 PARK GRANADA STE 202
Second Line :
City : CALABASAS
State : CA
Zip : 91302-1666
Country : US
Telephone Number : 310-684-3610
Fax Number : 310-693-2502
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2009
Last Update Date : 03/05/2024

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