Individual
DR. MARY LOUISE LANE-CARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
EDD, MPH, RD, CDE
Contact information
Practice address
16132 CRESTLINE DR, LA MIRADA, CA 90638-3458
(562) 947-5860
Mailing address
16132 CRESTLINE DR, LA MIRADA, CA 90638-3458
(562) 947-5860
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
R615454
CA
Other
Enumeration date
10/19/2012
Last updated
10/19/2012
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