MEDICARE: MRS. KRISTIN A BIDDLE R.D.

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	860543	CA

General Provider Information

NPI Number	:	1750091336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTIN A BIDDLE R.D.

Provider Business Mailing Address
First Line	:	3121 BRIMHALL DR
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-5206
Country	:	US
Telephone Number	:	562-394-3780
Fax Number	:

Provider Business Practice Location Address
First Line	:	3121 BRIMHALL DR
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-5206
Country	:	US
Telephone Number	:	562-394-3780
Fax Number	:

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

Provider Enumeration Date	:	12/05/2022
Last Update Date	:	12/05/2022

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