Provider Demographics
NPI:1871002162
Name:ESTES BRUFF, VICKI DORISSE (RDN)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:DORISSE
Last Name:ESTES BRUFF
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1288
Mailing Address - Street 2:
Mailing Address - City:HOOPA
Mailing Address - State:CA
Mailing Address - Zip Code:95546-1288
Mailing Address - Country:US
Mailing Address - Phone:269-221-1213
Mailing Address - Fax:
Practice Address - Street 1:535 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:HOOPA
Practice Address - State:CA
Practice Address - Zip Code:95546-9615
Practice Address - Country:US
Practice Address - Phone:530-625-4261
Practice Address - Fax:530-625-4519
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
591283133V00000X
CA591293133V00000X
591293133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered