Individual
MS. KIM MARIE VAGT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD, CDE
Contact information
Practice address
200 MISSION BLVD, JACKSON, CA 95642-2564
(209) 223-7430
(209) 257-7634
Mailing address
200 MISSION BLVD, JACKSON, CA 95642-2564
(209) 223-7430
(209) 257-7634
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
013949
CA
Other
Enumeration date
01/26/2011
Last updated
01/26/2011
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