Individual
ALFREDA SULISTIOWATI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
24850 PROSPECT AVE APT D, LOMA LINDA, CA 92354-2843
(310) 309-1644
Mailing address
24850 PROSPECT AVE APT D, LOMA LINDA, CA 92354-2843
(310) 309-1644
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
1099864
CA
Other
Enumeration date
06/01/2012
Last updated
06/01/2012
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