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General NPI Number Information
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NPI Number | 1831855311
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Entity Type | Organization
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Legal Business Name | VALLEY REGISTERED DIETITIAN NETWORK
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Dates
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Enumeration Date | 11/09/2021
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Last Update Date | 04/24/2026
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Provider Practice Location Address
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Address Line | 1805 N CALIFORNIA ST STE 308
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City | STOCKTON
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State | CA
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Zip | 95204-6032
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Country | US
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Telephone | 209-227-0722
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Fax | 866-862-8832
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Provider Business Mailing Address
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Address Line | 1805 N CALIFORNIA ST STE 308
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City | STOCKTON
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State | CA
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Zip | 95204-6032
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Country | US
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Telephone | 209-227-0722
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Fax | 866-862-8832
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MACIE YOUNG
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Credential |
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Telephone | 916-407-6732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1301X
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Taxonomy Name | Oncology Nutrition Registered Dietitian
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License Number |
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License Number State |
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