Individual
KELSEA JOHANNA PALACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1036705
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB280422
MEDICARE
CA
Enumeration date
04/04/2016
Last updated
07/27/2026
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