Provider Demographics
NPI:1487877916
Name:HELMICK, ELAINE CONSTANCE (MS, RD)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:CONSTANCE
Last Name:HELMICK
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 BAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-3057
Mailing Address - Country:US
Mailing Address - Phone:949-244-1452
Mailing Address - Fax:
Practice Address - Street 1:441 N LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-3028
Practice Address - Country:US
Practice Address - Phone:714-279-4163
Practice Address - Fax:714-279-5213
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA874875133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
874875OtherREGISTRATION ID NUMBER