Individual
KENI DENISE LOPEZ SEVILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, CLEC
Contact information
Practice address
10950 BROOKE DR APT 51320, SAN DIEGO, CA 92126-5083
(559) 365-1274
Mailing address
10950 BROOKE DR APT 51320, SAN DIEGO, CA 92126-5083
(559) 365-1274
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
CA
Other
Enumeration date
09/22/2020
Last updated
05/04/2022
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