Provider Demographics
NPI:1770031148
Name:PACA, ELIZABETH CLAYE (MS, RD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CLAYE
Last Name:PACA
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12018 W BROAD ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-7796
Mailing Address - Country:US
Mailing Address - Phone:804-360-0600
Mailing Address - Fax:804-360-0601
Practice Address - Street 1:12018 W BROAD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-7796
Practice Address - Country:US
Practice Address - Phone:804-360-0600
Practice Address - Fax:804-360-0601
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1030205133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered