Healthcare Provider Details

I. General information

NPI: 1447886189
Provider Name (Legal Business Name): GRACE ELIZABETH AGUIRRE RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 11/01/2023
Certification Date: 10/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 TAMARAK COURT
PLUMAS LAKE CA
95961
US

IV. Provider business mailing address

755 TAMARACK CT
PLUMAS LAKE CA
95961-1009
US

V. Phone/Fax

Practice location:
  • Phone: 916-807-0247
  • Fax:
Mailing address:
  • Phone: 916-807-0247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86116426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: