Provider Demographics
NPI:1992084560
Name:GUERARD, SUSAN PETRABORG (RD)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:PETRABORG
Last Name:GUERARD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 MCPHERSON LN
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-3571
Mailing Address - Country:US
Mailing Address - Phone:661-664-9327
Mailing Address - Fax:661-664-9327
Practice Address - Street 1:1509 MCPHERSON LN
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3571
Practice Address - Country:US
Practice Address - Phone:661-664-9327
Practice Address - Fax:661-664-9327
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR511654133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered