MEDICARE: BRETA ALSTROM RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	86089380	OTHER		COMMISSION ON DIETETIC REGISTRATION

General Provider Information

NPI Number	:	1003388430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETA ALSTROM RD

Provider Business Mailing Address
First Line	:	701 W RIO SALADO PKWY APT 1017
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85281-3739
Country	:	US
Telephone Number	:	620-491-3249
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 W RIO SALADO PKWY APT 1017
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85281-3739
Country	:	US
Telephone Number	:	620-491-3249
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/25/2018
Last Update Date	:	09/03/2025

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Directions to “ BRETA ALSTROM RD” Practice Location

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