Provider Demographics
NPI:1700119971
Name:LE BON, SUZANNE M (RD, CNSC, CLC)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:M
Last Name:LE BON
Suffix:
Gender:F
Credentials:RD, CNSC, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 GRANITE ST
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-4014
Mailing Address - Country:US
Mailing Address - Phone:831-641-0576
Mailing Address - Fax:
Practice Address - Street 1:611 GRANITE ST
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-4014
Practice Address - Country:US
Practice Address - Phone:831-641-0576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-06
Last Update Date:2009-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA716127133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric