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Organization
MNT SCIENTIFIC
Active
Organization
MNT SCIENTIFIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRICK LACKMANN TRAYNOR RD (OWNER)
(909) 653-3471
Entity
Organization
Contact information
Practice address
3079 HARRISON AVE, SOUTH LAKE TAHOE, CA 96150
(909) 653-3471
(949) 260-0134
Mailing address
671 RIVER RANCH ROAD, MARKLEEVILLE, CA 96120
(909) 653-3471
(949) 269-0134
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
08/08/2023
Last updated
09/29/2023
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