Individual
JENIFER LA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LDN
Contact information
Practice address
218 SCHOOL ST, WALTHAM, MA 02451-4551
(617) 818-7672
Mailing address
218 SCHOOL ST, WALTHAM, MA 02451-4551
(617) 818-7672
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
4069
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
086030572
CDR
MA
Enumeration date
05/15/2020
Last updated
05/15/2020
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