Individual
MS. LORI THACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
SAN DIEGO VA HEALTHCARE SYSTEM, 3350 LA JOLLA VILLAGE DRIVE, SAN DIEGO, CA 92161-0001
(858) 552-8585
Mailing address
2004 AVENUE OF THE TREES, CARLSBAD, CA 92008-1104
(760) 201-7665
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
915135
CA
Other
Enumeration date
10/05/2008
Last updated
10/05/2008
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