MEDICARE: LIA BERJIS MS, 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
1	133V00000X	Registered Dietitian	1011581	CA

General Provider Information

NPI Number	:	1659671964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIA BERJIS MS, RD

Provider Business Mailing Address
First Line	:	1451 PRINCETON ST APT 4
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-3032
Country	:	US
Telephone Number	:	310-754-9266
Fax Number	:	310-310-3063

Provider Business Practice Location Address
First Line	:	1451 PRINCETON ST APT 4
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-3032
Country	:	US
Telephone Number	:	310-754-9266
Fax Number	:	310-310-3063

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

Provider Enumeration Date	:	11/02/2010
Last Update Date	:	11/02/2010

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