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General NPI Number Information
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NPI Number | 1184363954
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Entity Type | Individual
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Provider Name | TEARSA DEBARDELEBEN RD, LD
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Gender | Female
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Dates
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Enumeration Date | 05/31/2022
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Last Update Date | 07/19/2022
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Provider Practice Location Address
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Address Line | 388 YPAO RD # 9
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City | TAMUNING
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State | GU
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Zip | 96913-3701
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Country | US
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Telephone | 671-777-4501
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Fax |
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Provider Business Mailing Address
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Address Line | 388 YPAO RD
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City | TAMUNING
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State | GU
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Zip | 96913-3701
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Country | US
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Telephone |
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Fax | 671-646-1292
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | D-055
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License Number State | GU
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DT85534
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | D-055
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License Number State | GU
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