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General NPI Number Information
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NPI Number | 1427717552
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Entity Type | Individual
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Provider Name | SAMANTHA WALLING RD
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Gender | Female
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Dates
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Enumeration Date | 12/16/2021
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Last Update Date | 12/16/2021
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Provider Practice Location Address
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Address Line | 4647 ZION AVE
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City | SAN DIEGO
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State | CA
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Zip | 92120-2507
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Country | US
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Telephone | 619-782-2795
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Fax |
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Provider Business Mailing Address
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Address Line | 9772 ABBEYFIELD RD
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City | SANTEE
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State | CA
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Zip | 92071-2605
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Country | US
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Telephone | 209-625-7061
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86098895
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License Number State | CA
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