Individual
BROOKE WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RDN, CSSD
Contact information
Practice address
24642 VIA RAZA, LAKE FOREST, CA 92630-2043
(949) 683-5210
Mailing address
24642 VIA RAZA, LAKE FOREST, CA 92630-2043
Taxonomy
Speciality
Code
Description
License number
State
133VN1501X
Sports Dietetics Nutrition Registered Dietitian
Primary
—
—
Other
Enumeration date
12/29/2022
Last updated
12/29/2022
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