Individual
TONYA LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
4097 TRAIL CREEK RD, RIVERSIDE, CA 92505-5869
(909) 472-2107
Mailing address
6211 SIERRA AVE, FONTANA, CA 92336-1216
(909) 472-2107
Taxonomy
Speciality
Code
Description
License number
State
132700000X
Dietary Manager
Primary
86091431
CA
Other
Enumeration date
10/05/2022
Last updated
10/05/2022
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