Individual
MISS MARIAM BOULAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS RD
Contact information
Practice address
43112 15TH ST W # 93534, LANCASTER, CA 93534-6219
(661) 726-2222
Mailing address
3316 MONTELLANO AVE, PALMDALE, CA 93551-4805
(310) 592-5368
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
999205
CA
Other
Enumeration date
09/30/2011
Last updated
09/30/2011
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