Individual
LAURA AUDREY OMIDVARAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
10501 GOLF COURSE RD NW, ALBUQUERQUE, NM 87114-5019
(505) 727-2369
(505) 727-2291
Mailing address
4512 SNOWFLAKE DR NW, ALBUQUERQUE, NM 87114-4287
(505) 897-9791
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
311
NM
Other
Enumeration date
02/24/2009
Last updated
02/24/2009
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