Healthcare Provider Details

I. General information

NPI: 1699432377
Provider Name (Legal Business Name): GAYLE LYNN HOXTER RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GAYLE LYNN SHOCKEY RDN

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 11/17/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 RIVERWALK PKWY STE 400
RIVERSIDE CA
92505-3313
US

IV. Provider business mailing address

PO BOX 60
PALA CA
92059-0060
US

V. Phone/Fax

Practice location:
  • Phone: 951-453-9083
  • Fax:
Mailing address:
  • Phone: 951-551-8009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number611341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: