Basic Information
| Provider Information | |||||||||
| NPI: | 1871002162 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ESTES BRUFF | ||||||||
| FirstName: | VICKI | ||||||||
| MiddleName: | DORISSE | ||||||||
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| Credential: | RDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1288 | ||||||||
| Address2: | |||||||||
| City: | HOOPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955461288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2692211213 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 535 AIRPORT RD | ||||||||
| Address2: | |||||||||
| City: | HOOPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955469615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306254261 | ||||||||
| FaxNumber: | 5306254519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2017 | ||||||||
| LastUpdateDate: | 04/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 133V00000X | 591283 | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | 133V00000X | 591293 | CA | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 133V00000X | 591293 | N | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.