Provider Demographics
NPI:1194361618
Name:LEE, REBECCA MARIE (RD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:LEE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MARIE
Other - Last Name:BISCARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 BARTOL ST # 1238
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-4501
Mailing Address - Country:US
Mailing Address - Phone:805-453-6710
Mailing Address - Fax:
Practice Address - Street 1:18 BARTOL ST # 1238
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4501
Practice Address - Country:US
Practice Address - Phone:805-453-6710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86085180133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered