Provider Demographics
NPI:1003388430
Name:ALSTROM, BRETA (RD)
Entity type:Individual
Prefix:
First Name:BRETA
Middle Name:
Last Name:ALSTROM
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 1:701 W RIO SALADO PKWY APT 1017
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-3739
Mailing Address - Country:US
Mailing Address - Phone:620-491-3249
Mailing Address - Fax:
Practice Address - Street 1:701 W RIO SALADO PKWY APT 1017
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-3739
Practice Address - Country:US
Practice Address - Phone:620-491-3249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-25
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86089380OtherCOMMISSION ON DIETETIC REGISTRATION