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Individual

JUSTIN MATTHEW WALLER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
RDN

Contact information

Practice address
500 E FOOTHILL BLVD APT 5, SAN LUIS OBISPO, CA 93405-1629
(916) 402-6914
Mailing address
500 E FOOTHILL BLVD APT 5, SAN LUIS OBISPO, CA 93405-1629
(916) 402-6914

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86119710
CA

Other

Enumeration date
09/27/2022
Last updated
09/27/2022
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