Betty Licciardo, RD in Pomona, CA - Medicare Dietitian, Registered Provider

Betty Licciardo, RD is a medicare enrolled "Dietitian, Registered" provider in Pomona, California. Her current practice location is 1904 N Orange Grove Ave, Pomona, California. You can reach out to her office (for appointments etc.) via phone at (909) 469-1823.

Betty Licciardo is licensed to practice in * (Not Available) (license number 718614) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1043265622.

Contact Information

	Betty Licciardo, RD
	1904 N Orange Grove Ave, Pomona, CA 91767-3008
	(909) 469-1823
	(909) 469-1827

Map and Direction

Healthcare Provider's Profile

Full Name	Betty Licciardo
Gender	Female
Speciality	Dietitian, Registered
Location	1904 N Orange Grove Ave, Pomona, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1043265622
Provider Enumeration Date: 05/23/2006
Last Update Date: 09/20/2021

Medicare PECOS Information:

PECOS PAC ID: 0941262976
Enrollment ID: I20041101001089

Medical Identifiers

Medical identifiers for Betty Licciardo such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1043265622	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
133V00000X	Dietitian, Registered	718614 (* (Not Available))	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Betty Licciardo allows following entities to bill medicare on her behalf.

Provider Name	Chaparral Medical Group Inc
Provider Type	Part B Supplier - Clinic/group Practice
Provider Identifiers	NPI Number: 1477733624 PECOS PAC ID: 6800709403 Enrollment ID: O20031110000605

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Betty Licciardo is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Betty Licciardo, RD 840 Towne Center Drive, Chaparral Medical Group Inc, Pomona, CA 91767-5900 Ph: (909) 398-1550	Betty Licciardo, RD 1904 N Orange Grove Ave, Pomona, CA 91767-3008 Ph: (909) 469-1823

Reviews and Comments

Dietitian, Registered in Pomona, CA

Maria Consuelo Castelan, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 1798 N Garey Ave, Pomona, CA 91767 Phone: 909-528-5046
Hsienhwa Chou, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 1798 N Garey Ave, Pomona, CA 91767 Phone: 909-860-7799
Jenjira Sorreca Do, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 1798 N Garey Ave, Pomona, CA 91767 Phone: 909-865-9501
Inland Valley Disease Management Clinic Dietitian Medicare: Not Enrolled in Medicare Practice Location: 1904 N Orange Grove Ave, Pomona, CA 91767 Phone: 909-469-1823 Fax: 909-469-1827
Teresa Landis, Dietitian Medicare: Not Enrolled in Medicare Practice Location: 255 E Bonita Ave, 2nd Floor, Suite 200, Pomona, CA 91767 Phone: 909-519-3207
Chaparral Medical Group Inc Dietitian Medicare: Not Enrolled in Medicare Practice Location: 1904 N Orange Grove Ave, Chaparral Medical Group, Pomona, CA 91767 Phone: 909-469-1823 Fax: 909-469-1827

Betty Licciardo, RD - Medicare Dietitian in Pomona, CA