Healthcare Provider Details

I. General information

NPI: 1932577038
Provider Name (Legal Business Name): ESTRELLA WALKER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ESTRELLA ATKINSON RD

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6809 INDIANA AVE STE #130-A55
RIVERSIDE CA
92506-4221
US

IV. Provider business mailing address

24123 FIR AVE
MORENO VALLEY CA
92553-2837
US

V. Phone/Fax

Practice location:
  • Phone: 951-374-3710
  • Fax: 951-231-1501
Mailing address:
  • Phone: 951-374-3710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1067219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: