Provider Demographics
NPI:1629384474
Name:RICKRODE, TAYLOR MARIE (RD)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:MARIE
Last Name:RICKRODE
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 1:20251 CAPE CORAL LN
Mailing Address - Street 2:STE 118
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-8517
Mailing Address - Country:US
Mailing Address - Phone:805-264-2455
Mailing Address - Fax:
Practice Address - Street 1:20251 CAPE CORAL LN
Practice Address - Street 2:STE 118
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-8517
Practice Address - Country:US
Practice Address - Phone:805-264-2455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1033713133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered