Provider Demographics
NPI:1730196213
Name:KUROKAWA, REBECCA (MS, RD, LD, CNSC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:KUROKAWA
Suffix:
Gender:F
Credentials:MS, RD, LD, CNSC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:NEWSOME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD, CNSC
Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:DEPARTMENT OF NUTRITIONAL MEDICINE
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:DEPARTMENT OF NUTRITIONAL MEDICINE
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered