Healthcare Provider Details

I. General information

NPI: 1659612430
Provider Name (Legal Business Name): CHRISTINA RUVALCABA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 E SAN JACINTO AVE
PERRIS CA
92570-2878
US

IV. Provider business mailing address

13442 FAIRFIELD DR
CORONA CA
92883-6629
US

V. Phone/Fax

Practice location:
  • Phone: 951-264-9798
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1021291
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1021291
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1021291
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: