Individual
KELLY BLASCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN
Contact information
Practice address
633 W 5TH ST, LOS ANGELES, CA 90071-2005
(323) 391-7262
Mailing address
1048 IRVINE AVE # 768, NEWPORT BEACH, CA 92660-4602
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86094015
CA
Other
Enumeration date
06/10/2020
Last updated
06/10/2020
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