Provider Demographics
NPI:1477612679
Name:GARCIA, SUSAN L (RD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:GARCIA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:L
Other - Last Name:BOHANAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:19920 GRANITE DR UNIT 214
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-9088
Mailing Address - Country:US
Mailing Address - Phone:925-255-3060
Mailing Address - Fax:
Practice Address - Street 1:19920 GRANITE DR UNIT 214
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-9088
Practice Address - Country:US
Practice Address - Phone:925-255-3060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06200133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ04280ZMedicare PIN