Healthcare Provider Details

I. General information

NPI: 1538438155
Provider Name (Legal Business Name): MELANIE TERESA BARBEE MS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANIE T. BARRY

II. Dates (important events)

Enumeration Date: 12/28/2011
Last Update Date: 08/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 E 2ND ST SUITE 4
POMONA CA
91766-2007
US

IV. Provider business mailing address

795 E 2ND ST SUITE 4
POMONA CA
91766-2007
US

V. Phone/Fax

Practice location:
  • Phone: 909-706-3779
  • Fax: 909-865-2955
Mailing address:
  • Phone: 909-706-3779
  • Fax: 909-865-2955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number717221
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number717221
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number717221
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number717221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: