Provider Demographics
NPI:1366302648
Name:BALDRY, MARISSA (MS, RD)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:BALDRY
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:THIRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD
Mailing Address - Street 1:2205 FLORIDA ST UNIT 102
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-5992
Mailing Address - Country:US
Mailing Address - Phone:630-450-3242
Mailing Address - Fax:
Practice Address - Street 1:2205 FLORIDA ST UNIT 102
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-5992
Practice Address - Country:US
Practice Address - Phone:630-450-3242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-18
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered