Provider Demographics
NPI:1669718102
Name:DESOTO, ELIZABETH DAWN (RD)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:DAWN
Last Name:DESOTO
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 1:5509 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-5604
Mailing Address - Country:US
Mailing Address - Phone:530-520-3581
Mailing Address - Fax:
Practice Address - Street 1:5509 LONGVIEW DR
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-5604
Practice Address - Country:US
Practice Address - Phone:530-520-3581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-01
Last Update Date:2013-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15005133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered