Provider Demographics
NPI:1437984762
Name:WEIGHT INCLUSIVE DIETITIAN, PC
Entity type:Organization
Organization Name:WEIGHT INCLUSIVE DIETITIAN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRADENA
Authorized Official - Middle Name:N
Authorized Official - Last Name:RAYNER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, CDN
Authorized Official - Phone:716-495-3513
Mailing Address - Street 1:8605 SANTA MONICA BLVD # 377971
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4109
Mailing Address - Country:US
Mailing Address - Phone:213-377-9160
Mailing Address - Fax:
Practice Address - Street 1:44053 BUCKEYE CT
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-7807
Practice Address - Country:US
Practice Address - Phone:213-377-9160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty