Provider Demographics
NPI:1710233911
Name:ACKERMAN, EILEEN MARY (RD)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:MARY
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 GARDEN VIEW RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2477
Mailing Address - Country:US
Mailing Address - Phone:760-944-0223
Mailing Address - Fax:760-436-8739
Practice Address - Street 1:1200 GARDEN VIEW RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2477
Practice Address - Country:US
Practice Address - Phone:760-944-0223
Practice Address - Fax:760-436-8739
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education