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Individual

LACY STUART KELLY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MS

Contact information

Practice address
2331 GLYNDON AVE, VENICE, CA 90291-4044
(203) 249-2254
Mailing address
2331 GLYNDON AVE, VENICE, CA 90291-4044
(203) 249-2254

Taxonomy

Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary

Other

Enumeration date
11/13/2024
Last updated
11/13/2024
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