Individual
MISS AUDRA L GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
1600 SAN FERNANDO RD, SAN FERNANDO, CA 91340-3115
(818) 365-8086
Mailing address
1172 N MACLAY AVE, SAN FERNANDO, CA 91340-1328
(818) 898-1388
(818) 270-9590
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
948201
CA
Other
Enumeration date
01/11/2008
Last updated
01/11/2008
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