Provider Demographics
NPI:1689191256
Name:DEHAMER, REBECCA LORRAINE (MS, RD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LORRAINE
Last Name:DEHAMER
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6677 GREEN GABLES AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-2951
Mailing Address - Country:US
Mailing Address - Phone:510-472-6288
Mailing Address - Fax:
Practice Address - Street 1:6677 GREEN GABLES AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-2951
Practice Address - Country:US
Practice Address - Phone:510-472-6288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86011087133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered