Basic Information
| Provider Information | |||||||||
| NPI: | 1457776460 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAMORINDA FAMILY NUTRITION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 938 DEWING AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945494271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9253600061 | ||||||||
| FaxNumber: | 9253857019 | ||||||||
| Practice Location | |||||||||
| Address1: | 938 DEWING AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945494271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9253600061 | ||||||||
| FaxNumber: | 9253857019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2014 | ||||||||
| LastUpdateDate: | 02/27/2014 | ||||||||
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| AuthorizedOfficialLastName: | SAWYER | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIETITIAN | ||||||||
| AuthorizedOfficialTelephone: | 9253600061 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RDN, CLT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.