Provider Demographics
NPI:1548302425
Name:INKLEBARGER, SYDNIE FOMBY (MS,RD,CDE)
Entity type:Individual
Prefix:MRS
First Name:SYDNIE
Middle Name:FOMBY
Last Name:INKLEBARGER
Suffix:
Gender:F
Credentials:MS,RD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5880 BERTRO DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-1823
Mailing Address - Country:US
Mailing Address - Phone:619-466-1408
Mailing Address - Fax:
Practice Address - Street 1:5880 BERTRO DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-1823
Practice Address - Country:US
Practice Address - Phone:619-466-1408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered