Provider Demographics
NPI:1356954283
Name:BEYDOUN, DALIA SIADA (RD)
Entity type:Individual
Prefix:
First Name:DALIA
Middle Name:SIADA
Last Name:BEYDOUN
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 1:3843 S BRISTOL ST # 175
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7426
Mailing Address - Country:US
Mailing Address - Phone:559-301-7314
Mailing Address - Fax:
Practice Address - Street 1:3100 AIRWAY AVE STE 139
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4614
Practice Address - Country:US
Practice Address - Phone:949-409-5676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-29
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86010806133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered