Healthcare Provider Details

I. General information

NPI: 1376792895
Provider Name (Legal Business Name): DALIA DE JESUS MED RD CD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 UNITY ST
BELLINGHAM WA
98225-4429
US

IV. Provider business mailing address

220 UNITY ST
BELLINGHAM WA
98225-4429
US

V. Phone/Fax

Practice location:
  • Phone: 360-676-6177
  • Fax: 360-671-3574
Mailing address:
  • Phone: 360-676-6177
  • Fax: 360-671-3574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberCDR# 727157
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: