Provider Demographics
NPI:1144096140
Name:CHILDERS, GABRIELLA (RDN)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:CHILDERS
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 1:2945 CALLE GUADALAJARA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-3041
Mailing Address - Country:US
Mailing Address - Phone:864-918-0222
Mailing Address - Fax:
Practice Address - Street 1:2945 CALLE GUADALAJARA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-3041
Practice Address - Country:US
Practice Address - Phone:864-918-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC86170472133VN1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics