Individual
JODIE ELIZABETH WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
4501 SAND CREEK RD, ANTIOCH, CA 94531-8687
(925) 813-7600
Mailing address
4501 SAND CREEK RD, ANTIOCH, CA 94531-8687
(925) 813-7600
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86100110
CA
Other
Enumeration date
08/30/2018
Last updated
08/30/2018
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