Provider Demographics
NPI:1851412944
Name:GRINDE-BUSALACCHI, KENDRA ANN (RDN, CDE)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:ANN
Last Name:GRINDE-BUSALACCHI
Suffix:
Gender:F
Credentials:RDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 ALBATROSS DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1906
Mailing Address - Country:US
Mailing Address - Phone:406-698-4068
Mailing Address - Fax:
Practice Address - Street 1:4205 ALBATROSS DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1906
Practice Address - Country:US
Practice Address - Phone:406-698-4068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
925982133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered