Healthcare Provider Details

I. General information

NPI: 1780798967
Provider Name (Legal Business Name): STACY EVAN EFIRD R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W HERNDON AVE
CLOVIS CA
93612-0204
US

IV. Provider business mailing address

30 N TAMMI CT
CLOVIS CA
93611-5326
US

V. Phone/Fax

Practice location:
  • Phone: 559-324-6204
  • Fax:
Mailing address:
  • Phone: 559-259-1166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number933560
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: