Provider Demographics
NPI:1932717139
Name:THE DIET DUCHESS LLC
Entity Type:Organization
Organization Name:THE DIET DUCHESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTRELLA
Authorized Official - Middle Name:FORD
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:951-374-3710
Mailing Address - Street 1:6809 INDIANA AVE OFC 130-A55
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4221
Mailing Address - Country:US
Mailing Address - Phone:951-374-3710
Mailing Address - Fax:951-231-1501
Practice Address - Street 1:6809 INDIANA AVE OFC 130-A55
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4221
Practice Address - Country:US
Practice Address - Phone:951-374-3710
Practice Address - Fax:951-231-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1067219OtherCOMMISSION ON DIETETIC REGISTRATION NUMBER