Provider Demographics
NPI:1902683451
Name:DIGREGORIO, MARCY
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:
Last Name:DIGREGORIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3999 VIA LUCERO APT C9
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1617
Mailing Address - Country:US
Mailing Address - Phone:805-456-9927
Mailing Address - Fax:
Practice Address - Street 1:3999 VIA LUCERO APT C9
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1617
Practice Address - Country:US
Practice Address - Phone:805-456-9927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA944250133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty