Provider Demographics
NPI:1477599256
Name:ROPER, MARCIA RUTH (RD CDE)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:RUTH
Last Name:ROPER
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 768
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93258-0768
Mailing Address - Country:US
Mailing Address - Phone:559-784-2316
Mailing Address - Fax:559-781-6514
Practice Address - Street 1:380 NORTH RESERVATION RD
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-9673
Practice Address - Country:US
Practice Address - Phone:559-784-2316
Practice Address - Fax:559-781-6514
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RD893103133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q42038Medicare UPIN