Provider Demographics
NPI:1316173669
Name:REZNICK, STUART NATHAN (MPH, RD)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:NATHAN
Last Name:REZNICK
Suffix:
Gender:M
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 SHADY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-1337
Mailing Address - Country:US
Mailing Address - Phone:805-217-5525
Mailing Address - Fax:
Practice Address - Street 1:1955 SHADY BROOK DR
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-1337
Practice Address - Country:US
Practice Address - Phone:805-217-5525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01007969133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered