Provider Demographics
NPI:1710350699
Name:D'ABREU, MARISE ERMELINDA
Entity Type:Individual
Prefix:
First Name:MARISE
Middle Name:ERMELINDA
Last Name:D'ABREU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2166 HUNTINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-5823
Mailing Address - Country:US
Mailing Address - Phone:916-837-9726
Mailing Address - Fax:
Practice Address - Street 1:2166 HUNTINGTON CIR
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-5823
Practice Address - Country:US
Practice Address - Phone:916-837-9726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA961223133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered