Individual
POONAM MAHAJAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
ROUTE 301 NORTH B STREET, ZUNI, NM 87327-7405
(505) 782-4431
Mailing address
PO BOX 1765, ZUNI, NM 87327-1765
(505) 782-7358
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164005891
IL
Other
Enumeration date
04/26/2017
Last updated
04/26/2017
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