Provider Demographics
NPI:1346699774
Name:TACAD, DEBRA KIRSTY (RDN)
Entity Type:Individual
Prefix:
First Name:DEBRA KIRSTY
Middle Name:
Last Name:TACAD
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 BATSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-1936
Mailing Address - Country:US
Mailing Address - Phone:626-272-2047
Mailing Address - Fax:
Practice Address - Street 1:1506 BATSON AVE
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-1936
Practice Address - Country:US
Practice Address - Phone:626-272-2047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered