Provider Demographics
NPI:1093502536
Name:REBBAJ, YOUNES (RD/LD)
Entity type:Individual
Prefix:
First Name:YOUNES
Middle Name:
Last Name:REBBAJ
Suffix:
Gender:
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 S DELAWARE ST STE 130
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-2394
Mailing Address - Country:US
Mailing Address - Phone:650-319-8654
Mailing Address - Fax:
Practice Address - Street 1:3050 S DELAWARE ST STE 130
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2394
Practice Address - Country:US
Practice Address - Phone:650-319-8654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2530133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered