Provider Demographics
NPI:1144818519
Name:ROBERTS, REBECA ELAINE (RD)
Entity type:Individual
Prefix:
First Name:REBECA
Middle Name:ELAINE
Last Name:ROBERTS
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 1:521 E PINEHURST AVE
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-3966
Mailing Address - Country:US
Mailing Address - Phone:562-665-3816
Mailing Address - Fax:
Practice Address - Street 1:521 E PINEHURST AVE
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-3966
Practice Address - Country:US
Practice Address - Phone:562-665-3816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-01
Last Update Date:2021-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86111451133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered