MEDICARE: CARLY MICHELE ALBRECHT RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86314654	CA

General Provider Information

NPI Number	:	1578338752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY MICHELE ALBRECHT RD

Provider Business Mailing Address
First Line	:	30262 CROWN VALLEY PKWY STE B154
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-2364
Country	:	US
Telephone Number	:	949-287-3197
Fax Number	:

Provider Business Practice Location Address
First Line	:	30262 CROWN VALLEY PKWY STE B154
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-2364
Country	:	US
Telephone Number	:	949-287-3197
Fax Number	:	833-924-4470

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2023
Last Update Date	:	05/26/2026

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