Provider Demographics
NPI:1598310823
Name:BEIDLER, JOSHUA (RDN)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:
Last Name:BEIDLER
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3516 GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4618
Mailing Address - Country:US
Mailing Address - Phone:619-663-7036
Mailing Address - Fax:
Practice Address - Street 1:3516 GEORGIA ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4618
Practice Address - Country:US
Practice Address - Phone:619-663-7036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-04
Last Update Date:2019-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered