Individual
MRS. TRACY BENTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, CDCES, CSOWM
Contact information
Practice address
803 S SHORT LN, EAGLE, ID 83616-4122
(208) 954-0862
Mailing address
803 S SHORT LN, EAGLE, ID 83616-4122
(208) 954-0862
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
949867
CA
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
Primary
949867
CA
Other
Enumeration date
12/22/2006
Last updated
09/20/2023
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