Provider Demographics
NPI:1215815469
Name:REBELE, TARA (MPH, RDN, CNSC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:REBELE
Suffix:
Gender:F
Credentials:MPH, RDN, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 E TIMBER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-6407
Mailing Address - Country:US
Mailing Address - Phone:310-384-1546
Mailing Address - Fax:
Practice Address - Street 1:1124 E TIMBER RIDGE RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-6407
Practice Address - Country:US
Practice Address - Phone:310-384-1546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered