Healthcare Provider Details

I. General information

NPI: 1366026759
Provider Name (Legal Business Name): MARIA ELENI HALKIADAKIS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

3114 DICKENS ST
SAN DIEGO CA
92106-2624
US

IV. Provider business mailing address

3114 DICKENS ST
SAN DIEGO CA
92106-2624
US

V. Phone/Fax

Practice location:
  • Phone: 619-363-7601
  • Fax:
Mailing address:
  • Phone: 619-363-7601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: