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General NPI Number Information
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NPI Number | 1609462092
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Entity Type | Individual
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Provider Name | MISTY FAULKNER RDN
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Gender | Female
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Dates
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Enumeration Date | 12/18/2020
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Last Update Date | 12/18/2020
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Provider Practice Location Address
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Address Line | 50100 GOLSH RD
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City | VALLEY CENTER
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State | CA
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Zip | 92082-5338
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Country | US
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Telephone | 760-749-1410
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Fax |
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Provider Business Mailing Address
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Address Line | 833 VIA BARQUERO
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City | SAN MARCOS
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State | CA
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Zip | 92069-7395
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Country | US
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Telephone | 858-373-8146
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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 | 86151025
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License Number State | CA
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