Provider Demographics
NPI:1104079391
Name:BARBA, PATRICIA DIBENEDETTO (RD, LDN, MS, CSR)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DIBENEDETTO
Last Name:BARBA
Suffix:
Gender:F
Credentials:RD, LDN, MS, CSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7536 OLILI PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-2964
Mailing Address - Country:US
Mailing Address - Phone:808-394-1456
Mailing Address - Fax:
Practice Address - Street 1:7536 OLILI PL
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-2964
Practice Address - Country:US
Practice Address - Phone:808-394-1456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2533133V00000X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal