MEDICARE: DOMINIQUE OLIBRICE RD, RDN

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	86253754

General Provider Information

NPI Number	:	1447115548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIQUE OLIBRICE RD, RDN

Provider Business Mailing Address
First Line	:	13668 N 108TH DR
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85351-2668
Country	:	US
Telephone Number	:	602-717-7625
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 CHERRY AVE
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03103-5737
Country	:	US
Telephone Number	:	602-717-7625
Fax Number	:

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

Provider Enumeration Date	:	12/20/2025
Last Update Date	:	12/20/2025

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