Provider Demographics
NPI:1720325871
Name:BREMEL, ANNETTE (RD)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:BREMEL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16629 FOOTHILL BLVD
Mailing Address - Street 2:APT 204
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-1191
Mailing Address - Country:US
Mailing Address - Phone:530-355-1158
Mailing Address - Fax:
Practice Address - Street 1:16629 FOOTHILL BLVD
Practice Address - Street 2:APT 204
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-1191
Practice Address - Country:US
Practice Address - Phone:530-355-1158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI899147133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered