MEDICARE: MS. SUZANNE M LE BON RD, CNSC, CLC

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	133VN1004X	Pediatric Nutrition Registered Dietitian	716127	CA

General Provider Information

NPI Number	:	1700119971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUZANNE M LE BON RD, CNSC, CLC

Provider Business Mailing Address
First Line	:	611 GRANITE ST
Second Line	:
City	:	PACIFIC GROVE
State	:	CA
Zip	:	93950-4014
Country	:	US
Telephone Number	:	831-641-0576
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 GRANITE ST
Second Line	:
City	:	PACIFIC GROVE
State	:	CA
Zip	:	93950-4014
Country	:	US
Telephone Number	:	831-641-0576
Fax Number	:

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

Provider Enumeration Date	:	09/06/2009
Last Update Date	:	09/06/2009

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