Individual
AUSTIN LIGHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RDN
Contact information
Practice address
20 MODESTO, IRVINE, CA 92602-0930
(714) 469-1393
Mailing address
20 MODESTO, IRVINE, CA 92602-0930
(714) 469-1393
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1105553
NY
Other
Enumeration date
05/31/2018
Last updated
05/31/2018
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