Basic Information
| Provider Information | |||||||||
| NPI: | 1912123100 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THE | ||||||||
| FirstName: | MARIA ALICE | ||||||||
| MiddleName: | LAGOS | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD, RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10727 ROSEDALE HWY | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933123211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613241455 | ||||||||
| FaxNumber: | 6615875781 | ||||||||
| Practice Location | |||||||||
| Address1: | 10727 ROSEDALE HWY | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933123211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613241455 | ||||||||
| FaxNumber: | 6615875781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 12/10/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 932687 | CA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.