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NPI Code Detail

MEDICARE: MRS. LINDA VICKERS MS, RD, CDE

MEDICARE: MRS. LINDA VICKERS MS, RD, CDE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian579172CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MNT579172OTHERCAMEDICAL NUTRITION THERAPY

General Provider Information

NPI Number : 1144250614
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LINDA VICKERS MS, RD, CDE
Provider Business Mailing Address
First Line : 14442 RUTGER CIR
Second Line :
City : MOORPARK
State : CA
Zip : 93021-1323
Country : US
Telephone Number : 805-558-8343
Fax Number : 805-334-6377
Provider Business Practice Location Address
First Line : 1129 RED TAIL WAY
Second Line :
City : SIMI VALLEY
State : CA
Zip : 93065-7232
Country : US
Telephone Number : 805-558-8343
Fax Number : 805-334-6377
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2006
Last Update Date : 09/30/2015

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