Provider Demographics
NPI:1720379076
Name:SEIBER, MONICA LACEY (RD)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:LACEY
Last Name:SEIBER
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 1:61 VISTA LN
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507-2638
Mailing Address - Country:US
Mailing Address - Phone:562-221-7491
Mailing Address - Fax:
Practice Address - Street 1:61 VISTA LN
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:CA
Practice Address - Zip Code:94507-2638
Practice Address - Country:US
Practice Address - Phone:562-221-7491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA888121133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered