Provider Demographics
NPI:1003077603
Name:PORTHOUSE, REBECCA ELIZABETH (RD)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ELIZABETH
Last Name:PORTHOUSE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 E WASHINGTON AVE
Mailing Address - Street 2:APT 1106
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-2125
Mailing Address - Country:US
Mailing Address - Phone:408-326-9403
Mailing Address - Fax:
Practice Address - Street 1:555 E WASHINGTON AVE
Practice Address - Street 2:APT 1106
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-2125
Practice Address - Country:US
Practice Address - Phone:408-326-9403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01020916133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered