Individual
MR. EARL JUSTIN MACASO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.D.
Contact information
Practice address
1350 W COVINA BLVD, SAN DIMAS, CA 91773-3245
(909) 581-4324
Mailing address
10400 VIA PALMA, MONTCLAIR, CA 91763-4751
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1014480
CA
Other
Enumeration date
04/28/2010
Last updated
04/28/2010
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