Betty Licciardo RD

NPI 1043265622 - Dietitian, Registered - 133V00000X

NPI Details
NPI 1043265622
Gender Female
Enumeration Date 05/23/2006
Last Updated 05/12/2011
Entity Type Individual
Active Over 10 years ago
Practice Location
1915 ERVILLA AVE.
CHAPARRAL MEDICAL GROUP INC
POMONA CA, 91767-3008, US
Phone (909) 469-1823
Fax (909) 469-1827
Business Location
840 TOWNE CENTER DRIVE
CHAPARRAL MEDICAL GROUP INC
POMONA CA, 91767-5900, US
Phone (909) 398-1550
Fax (909) 398-1573
Toxanomy
Taxonomy Code 133V00000X
License State
License Number 718614
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According to our database, Betty Licciardo RD NPI is 1043265622, taxonomy code is 133V00000X and license number is 718614, license state is located at . Betty Licciardo RD physically located at 1915 Ervilla Ave., Pomona CA, 91767-3008. NPI Number Betty Licciardo RD has the Individual type.

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1043265622 NPI number is provided on an as is basis without warranty of any kind. 1043265622 is maintained by the National Plan & Provider Enumeration System. The contents of Betty Licciardo RD are for informational purposes only.