Healthcare Provider Details

I. General information

NPI: 1730043837
Provider Name (Legal Business Name): EASTERN SIERRA NUTRITION AND LACTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 MAY ST
BISHOP CA
93514-2709
US

IV. Provider business mailing address

425 CLARKE ST UNIT B
BISHOP CA
93514-3528
US

V. Phone/Fax

Practice location:
  • Phone: 760-920-6574
  • Fax: 760-582-4559
Mailing address:
  • Phone: 760-920-6574
  • Fax: 760-582-4559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: GRACE VOORHEIS
Title or Position: OWNER
Credential: RD, CSP, IBCLC
Phone: 909-210-1901