Provider Demographics
NPI:1699432377
Name:HOXTER, GAYLE LYNN (RDN)
Entity type:Individual
Prefix:
First Name:GAYLE
Middle Name:LYNN
Last Name:HOXTER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:GAYLE
Other - Middle Name:LYNN
Other - Last Name:SHOCKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:PO BOX 60
Mailing Address - Street 2:
Mailing Address - City:PALA
Mailing Address - State:CA
Mailing Address - Zip Code:92059-0060
Mailing Address - Country:US
Mailing Address - Phone:951-551-8009
Mailing Address - Fax:
Practice Address - Street 1:4210 RIVERWALK PKWY STE 400
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3313
Practice Address - Country:US
Practice Address - Phone:951-453-9083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA611341133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered