Individual
JACQUELINE BONANNO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
1718 SYLVAN WAY, #912, LODI, CA 95242-4318
(415) 533-5737
Mailing address
1718 SYLVAN WAY, #912, LODI, CA 95242-4318
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
942665
CA
Other
Enumeration date
02/10/2007
Last updated
07/08/2007
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