Provider Demographics
NPI:1174233233
Name:OULDIBBAT, LAILA (RD)
Entity type:Individual
Prefix:
First Name:LAILA
Middle Name:
Last Name:OULDIBBAT
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 1:11 DORCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-1410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 DORCHESTER RD
Practice Address - Street 2:
Practice Address - City:EASTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10709-1410
Practice Address - Country:US
Practice Address - Phone:914-471-7650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric