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Individual

MS. CARLY DENISE MAITLEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RD

Contact information

Practice address
9961 SIERRA AVE, FOOD AND NUTRITION SERVICES, FONTANA, CA 92335
(909) 427-7185
Mailing address
6153 PERIDOT AVE, ALTA LOMA, CA 91701
(909) 427-7185
(909) 427-4151

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
00966300
CA

Other

Enumeration date
05/09/2008
Last updated
05/09/2008
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