Healthcare Provider Details

I. General information

NPI: 1831553684
Provider Name (Legal Business Name): CHRISTY FITZPATRICK RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTY HELVESTINE RD

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1573 VISTA DEL MAR WAY UNIT 2
OCEANSIDE CA
92054-5986
US

IV. Provider business mailing address

1573 VISTA DEL MAR WAY UNIT 2
OCEANSIDE CA
92054-5986
US

V. Phone/Fax

Practice location:
  • Phone: 858-882-7708
  • Fax:
Mailing address:
  • Phone: 858-882-7708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number86016314
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number86016314
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License Number86016314
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86016314
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: