Provider Demographics
NPI:1841255874
Name:D'ANGELO, DEBRA S (RD, CDE)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:S
Last Name:D'ANGELO
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:S
Other - Last Name:DEMPSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:235 S PALISADE DR
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5948
Mailing Address - Country:US
Mailing Address - Phone:805-739-3561
Mailing Address - Fax:805-739-3560
Practice Address - Street 1:235 S PALISADE DR
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5948
Practice Address - Country:US
Practice Address - Phone:805-739-3561
Practice Address - Fax:805-739-3560
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164-004070133V00000X
CA840943133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK04837Medicare ID - Type Unspecified