Healthcare Provider Details

I. General information

NPI: 1508249954
Provider Name (Legal Business Name): CHELSEA GELINA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 CALABRIA ST
SANTEE CA
92071-5659
US

IV. Provider business mailing address

1302 CALABRIA ST
SANTEE CA
92071-5659
US

V. Phone/Fax

Practice location:
  • Phone: 619-701-7272
  • Fax:
Mailing address:
  • Phone: 619-701-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number947592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: