Provider Demographics
NPI:1740882141
Name:SOLBERGER, BLAIR (RD)
Entity type:Individual
Prefix:MR
First Name:BLAIR
Middle Name:
Last Name:SOLBERGER
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 29TH ST N # A
Mailing Address - Street 2:
Mailing Address - City:LEALMAN
Mailing Address - State:FL
Mailing Address - Zip Code:33714-1819
Mailing Address - Country:US
Mailing Address - Phone:850-294-3175
Mailing Address - Fax:
Practice Address - Street 1:5501 29TH ST N # A
Practice Address - Street 2:
Practice Address - City:LEALMAN
Practice Address - State:FL
Practice Address - Zip Code:33714-1819
Practice Address - Country:US
Practice Address - Phone:850-294-3175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND8790133VN1004X, 133VN1201X, 133VN1501X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics