Healthcare Provider Details

I. General information

NPI: 1023921897
Provider Name (Legal Business Name): MIA KRISTINE GLADDING RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 X ST
SACRAMENTO CA
95817-2214
US

IV. Provider business mailing address

2026 RIVERA PL
DAVIS CA
95618-7616
US

V. Phone/Fax

Practice location:
  • Phone: 800-282-3284
  • Fax:
Mailing address:
  • Phone: 530-309-8144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: