Individual
LISA MARIE GOURLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
9961 SIERRA AVE, FONTANA, CA 92335-6720
(909) 427-7263
Mailing address
1005 N CENTER AVE, APT 7303, ONTARIO, CA 91764-4856
(951) 733-4412
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
916500
CA
Other
Enumeration date
03/19/2007
Last updated
07/08/2007
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