MEDICARE: REBEKAH BAILEY RD, LD

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	86293795

General Provider Information

NPI Number	:	1609636042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBEKAH BAILEY RD, LD

Provider Business Mailing Address
First Line	:	4257 ALTURA MESA LN NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-5058
Country	:	US
Telephone Number	:	949-525-3099
Fax Number	:

Provider Business Practice Location Address
First Line	:	4257 ALTURA MESA LN NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-5058
Country	:	US
Telephone Number	:	949-525-3099
Fax Number	:

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

Provider Enumeration Date	:	03/21/2024
Last Update Date	:	03/21/2024

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