Provider Demographics
NPI:1568210805
Name:HARBOLIC, BETTY (MS, RDN, BCC)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:HARBOLIC
Suffix:
Gender:F
Credentials:MS, RDN, BCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6633 W VIA MONTOYA DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5714
Mailing Address - Country:US
Mailing Address - Phone:480-813-9988
Mailing Address - Fax:
Practice Address - Street 1:6633 W VIA MONTOYA DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-5714
Practice Address - Country:US
Practice Address - Phone:480-813-9988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 133VN1201X
838781133VN1101X
NY838781133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Gerontological
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management