Provider Demographics
NPI:1215354105
Name:GARIBALDI, JENNIFER ANN (RD, LDN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:GARIBALDI
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10223 BROADWAY ST STE P401
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7880
Mailing Address - Country:US
Mailing Address - Phone:658-484-6632
Mailing Address - Fax:
Practice Address - Street 1:9720 BROADWAY ST APT 216
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8454
Practice Address - Country:US
Practice Address - Phone:865-484-6632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-28
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
GALD005117133V00000X
TXDT86871133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered