=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972744050
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN MACDONALD R.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2009
-----------------------------------------------------
Last Update Date | 03/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26671 ALISO CREEK RD SUITE 304
-----------------------------------------------------
City | ALISO VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92656-4809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-389-9409
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23 BANSTEAD
-----------------------------------------------------
City | DOVE CANYON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92679-3740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-458-1487
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133NN1002X
-----------------------------------------------------
Taxonomy Name | Nutrition Education Nutritionist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133VN1006X
-----------------------------------------------------
Taxonomy Name | Metabolic Nutrition Registered Dietitian
-----------------------------------------------------
License Number | 817416
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------