Individual
ABBEY LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, CNSC
Contact information
Practice address
1800 N CALIFORNIA ST, STOCKTON, CA 95204-6019
(209) 467-2505
Mailing address
11860 CLAY STATION RD, HERALD, CA 95638-9773
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86154604
CA
Other
Enumeration date
03/03/2025
Last updated
03/03/2025
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