Individual
MARYSE S ETHIER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
3841 BASILONE ST UNIT 4, SAN DIEGO, CA 92110-5409
(706) 830-1159
Mailing address
3841 BASILONE ST UNIT 4, SAN DIEGO, CA 92110-5409
(706) 830-1159
Taxonomy
Speciality
Code
Description
License number
State
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
Primary
86115712
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86115712
CDR
—
Enumeration date
02/02/2021
Last updated
02/02/2021
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