Individual
SAMANTHA GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12530 BRADDOCK DR APT 222A, LOS ANGELES, CA 90066-6849
(310) 266-7102
Mailing address
12530 BRADDOCK DR APT 222A, LOS ANGELES, CA 90066-6849
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
—
Other
Enumeration date
10/30/2015
Last updated
10/30/2015
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