MEDICARE: MRS. JENNA MARIE BECKER-CORBIN R.D.

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	01004023	CA
2	133V00000X	Registered Dietitian	ND1405	FL

General Provider Information

NPI Number	:	1396047742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNA MARIE BECKER-CORBIN R.D.

Provider Business Mailing Address
First Line	:	5220 CARTILLA AVE
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91737-1756
Country	:	US
Telephone Number	:	909-731-9936
Fax Number	:

Provider Business Practice Location Address
First Line	:	4805 BAY HERON PL
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33616-2948
Country	:	US
Telephone Number	:	909-731-9936
Fax Number	:

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

Provider Enumeration Date	:	11/17/2010
Last Update Date	:	06/06/2014

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