Provider Demographics
NPI:1477706703
Name:EATON, VICKIE (RD, CDE)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:
Last Name:EATON
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:F
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, CDE
Mailing Address - Street 1:425 N DATE ST
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3413
Mailing Address - Country:US
Mailing Address - Phone:760-520-8372
Mailing Address - Fax:
Practice Address - Street 1:425 N DATE ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3413
Practice Address - Country:US
Practice Address - Phone:760-520-8372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL530759133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered