Provider Demographics
NPI:1457222911
Name:ACOSTA, REBEKAH (RDN)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 N BERLYN AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-3810
Mailing Address - Country:US
Mailing Address - Phone:909-994-0014
Mailing Address - Fax:
Practice Address - Street 1:423 N BERLYN AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-3810
Practice Address - Country:US
Practice Address - Phone:909-994-0014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty