Provider Demographics
NPI:1619365657
Name:BRUST, REBECCA (MS, RD, CDCES)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BRUST
Suffix:
Gender:F
Credentials:MS, RD, CDCES
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:ANDREWS / CLINTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:261 PANORAMA DR
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-1524
Mailing Address - Country:US
Mailing Address - Phone:425-214-3491
Mailing Address - Fax:
Practice Address - Street 1:261 PANORAMA DR
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-1524
Practice Address - Country:US
Practice Address - Phone:425-214-3491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-29
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1019162133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered