Healthcare Provider Details

I. General information

NPI: 1386289825
Provider Name (Legal Business Name): STEVEN RICHARD LINDSAY RD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 N PEACH AVE STE A1
CLOVIS CA
93611-7248
US

IV. Provider business mailing address

755 N PEACH AVE STE A1
CLOVIS CA
93611-7248
US

V. Phone/Fax

Practice location:
  • Phone: 559-392-8090
  • Fax:
Mailing address:
  • Phone: 559-321-7836
  • Fax: 559-795-5261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number340625
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86116034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: