Provider Demographics
NPI:1952043903
Name:BABCOCK, ANGELA (DIETITIAN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2903 PINEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434
Mailing Address - Country:US
Mailing Address - Phone:602-561-1105
Mailing Address - Fax:
Practice Address - Street 1:7281 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1592
Practice Address - Country:US
Practice Address - Phone:702-870-7050
Practice Address - Fax:702-870-7616
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty