Individual
LARISA WALK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1604 SUNRISE AVE, MADERA, CA 93638-4926
(559) 675-7623
Mailing address
2656 E LESTER AVE, FRESNO, CA 93720-5353
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
869662
CA
174N00000X
Lactation Consultant (Non-RN)
L-37208
CA
Other
Enumeration date
05/16/2020
Last updated
05/16/2020
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