Provider Demographics
NPI:1962709022
Name:DOROTHY BERNET, INC.
Entity type:Organization
Organization Name:DOROTHY BERNET, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNET
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CPT
Authorized Official - Phone:310-828-6100
Mailing Address - Street 1:2225 BROADWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2976
Mailing Address - Country:US
Mailing Address - Phone:310-828-6100
Mailing Address - Fax:310-828-6177
Practice Address - Street 1:2225 BROADWAY
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2976
Practice Address - Country:US
Practice Address - Phone:310-828-6100
Practice Address - Fax:310-828-6177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA865470133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty