Provider Demographics
NPI:1295453108
Name:BAEZ, BARBARA DARLINE (MS, RD/RDN)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:DARLINE
Last Name:BAEZ
Suffix:
Gender:F
Credentials:MS, RD/RDN
Other - Prefix:MISS
Other - First Name:BARBARA
Other - Middle Name:DARLINE
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD/RDN
Mailing Address - Street 1:11597 WILDFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2450
Mailing Address - Country:US
Mailing Address - Phone:805-433-2532
Mailing Address - Fax:
Practice Address - Street 1:11597 WILDFLOWER CT
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-2450
Practice Address - Country:US
Practice Address - Phone:805-433-2532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1003917133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered