Healthcare Provider Details

I. General information

NPI: 1477710432
Provider Name (Legal Business Name): DEVORAH PLEWINSKI MS RD CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 EDWARDS ST
BISHOP CA
93514-3304
US

IV. Provider business mailing address

192 EDWARD STREET
BISHOP CA
93514
US

V. Phone/Fax

Practice location:
  • Phone: 760-872-8313
  • Fax: 760-872-3754
Mailing address:
  • Phone: 760-872-8313
  • Fax: 760-872-3754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number892381
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number892381
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number892381
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: