Provider Demographics
NPI:1063086973
Name:BENNETT, FELICIA ANNE (RDN)
Entity type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:ANNE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3894 VIA LATO
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-1642
Mailing Address - Country:US
Mailing Address - Phone:951-642-0180
Mailing Address - Fax:
Practice Address - Street 1:3894 VIA LATO
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-1642
Practice Address - Country:US
Practice Address - Phone:951-642-0180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-15
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management