Individual
LAYLA ROSE WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
103 MEDICINE ROAD, PERIDOT, AZ 85542
(928) 475-1467
Mailing address
226 NATALIE AVE NW, ALBUQUERQUE, NM 87107-5237
(505) 967-8768
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD-0902
NM
Other
Enumeration date
12/26/2019
Last updated
12/26/2019
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