Individual
KELLY KOYANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
4168 FRONT ST, SAN DIEGO, CA 92103-2030
(619) 471-0420
Mailing address
3532 MEADE AVE APT 39, SAN DIEGO, CA 92116-3508
(805) 217-9048
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86057314
CA
Other
Enumeration date
11/14/2019
Last updated
11/14/2019
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