Provider Demographics
NPI:1174028500
Name:COBLENTZ, DEBRA (RD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:COBLENTZ
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 1:6270 WESTWIND WAY
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-7322
Mailing Address - Country:US
Mailing Address - Phone:775-426-8637
Mailing Address - Fax:
Practice Address - Street 1:550 N SHERMAN ST
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-3488
Practice Address - Country:US
Practice Address - Phone:775-423-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV39243-DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered