Provider Demographics
NPI:1780798967
Name:EFIRD, STACY EVAN (RD)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:EVAN
Last Name:EFIRD
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 1:30 N TAMMI CT
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-5326
Mailing Address - Country:US
Mailing Address - Phone:559-259-1166
Mailing Address - Fax:
Practice Address - Street 1:275 W HERNDON AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-0204
Practice Address - Country:US
Practice Address - Phone:559-324-6204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA933560133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03707ZMedicare UPIN
CAZZZ31616ZMedicare ID - Type Unspecified