Healthcare Provider Details

I. General information

NPI: 1609522689
Provider Name (Legal Business Name): MIKAELA DUFFY RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MIKAELA DUFFY RDN, LDN

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29970 TECHNOLOGY DR STE 118
MURRIETA CA
92563-2647
US

IV. Provider business mailing address

29970 TECHNOLOGY DR STE 118
MURRIETA CA
92563-2647
US

V. Phone/Fax

Practice location:
  • Phone: 951-365-7193
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1411
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: