Healthcare Provider Details

I. General information

NPI: 1487820080
Provider Name (Legal Business Name): PATRICIA ANN BEBO MS,RD,LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 RUTLAND SQ SUITE 2
BROCKTON MA
02301-6825
US

IV. Provider business mailing address

54 RUTLAND SQ SUITE 2
BROCKTON MA
02301-6825
US

V. Phone/Fax

Practice location:
  • Phone: 508-846-9554
  • Fax: 508-675-7467
Mailing address:
  • Phone: 508-846-9554
  • Fax: 508-675-7467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number210
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: