Audra L Gustafson RD

NPI 1790961456 - Dietitian, Registered - 133V00000X

NPI Details
NPI 1790961456
Gender Female
Enumeration Date 01/11/2008
Last Updated 01/11/2008
Entity Type Individual
Active Over 9 years ago
Practice Location
1600 SAN FERNANDO RD
SAN FERNANDO CA, 91340-3115, US
Phone (818) 365-8086
Fax
Business Location
1172 N MACLAY AVE
SAN FERNANDO CA, 91340-1328, US
Phone (818) 898-1388
Fax (818) 270-9590
Toxanomy
Taxonomy Code 133V00000X
License State California
License Number 948201
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According to our database, Miss Audra L Gustafson RD NPI is 1790961456, taxonomy code is 133V00000X and license number is 948201, license state is located at California. Audra L Gustafson RD physically located at 1600 San Fernando Rd, San Fernando CA, 91340-3115. NPI Number Audra L Gustafson RD has the Individual type.

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1790961456 NPI number is provided on an as is basis without warranty of any kind. 1790961456 is maintained by the National Plan & Provider Enumeration System. The contents of Audra L Gustafson RD are for informational purposes only.