MEDICARE: REBECCA VALDEZ LLC

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

General Provider Information

NPI Number	:	1144050824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REBECCA VALDEZ LLC

Provider Business Mailing Address
First Line	:	2638 S KEELING RD
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85193-8606
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2562 QUEENSTON RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-4352
Country	:	US
Telephone Number	:	646-740-1928
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED DIETITIAN
Name	:	REBECCA VALDEZ
Credential	:	RD
Telephone Number	:	646-740-1928

Provider Enumeration Date	:	08/06/2024
Last Update Date	:	08/06/2024

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