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General NPI Number Information
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NPI Number | 1588856975
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Entity Type | Individual
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Provider Name | DULCIA JERDAN RD
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Gender | Female
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 08/10/2007
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Provider Practice Location Address
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Address Line | 505 E CAPOVILLA AVE SUITE 105
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City | LAS VEGAS
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State | NV
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Zip | 89119-4340
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Country | US
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Telephone | 702-260-7329
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Fax |
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Provider Business Mailing Address
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Address Line | 505 E CAPOVILLA AVE SUITE 105
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City | LAS VEGAS
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State | NV
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Zip | 89119-4340
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Country | US
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Telephone | 702-260-7329
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Fax |
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 882891
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License Number State |
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