Provider Demographics
NPI:1487701603
Name:BERENSON, JOYCE BARBARA (RD, CDE)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:BARBARA
Last Name:BERENSON
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45740 PALMETTO WAY
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592
Mailing Address - Country:US
Mailing Address - Phone:951-676-0285
Mailing Address - Fax:844-249-5571
Practice Address - Street 1:45740 PALMETTO WAY
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6059
Practice Address - Country:US
Practice Address - Phone:951-676-0285
Practice Address - Fax:951-676-3225
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA832911133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ27756ZMedicare ID - Type Unspecified
CAQ04466Medicare UPIN