Provider Demographics
NPI:1598816795
Name:DIEBEL, ELOISE CLAIRE (RD)
Entity Type:Individual
Prefix:
First Name:ELOISE
Middle Name:CLAIRE
Last Name:DIEBEL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 MORSE AVE
Mailing Address - Street 2:DEPARTMENT OF ENDOCRINOLOGY
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2115
Mailing Address - Country:US
Mailing Address - Phone:916-973-7392
Mailing Address - Fax:916-973-7304
Practice Address - Street 1:2025 MORSE AVE
Practice Address - Street 2:DEPARTMENT OF ENDOCRINOLOGY
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2115
Practice Address - Country:US
Practice Address - Phone:916-973-7392
Practice Address - Fax:916-973-7304
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA431508133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered