Provider Demographics
NPI:1659129484
Name:BUNDICK, CHARITA NICHOLE (RD)
Entity type:Individual
Prefix:MRS
First Name:CHARITA
Middle Name:NICHOLE
Last Name:BUNDICK
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 1:414 S VIRGIL AVE APT S221
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1419
Mailing Address - Country:US
Mailing Address - Phone:757-323-1187
Mailing Address - Fax:
Practice Address - Street 1:414 S VIRGIL AVE APT S221
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1419
Practice Address - Country:US
Practice Address - Phone:757-323-1187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered