Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 95-4181648 | CA |
NPI | 1346404506 |
---|---|
Provider Name | Clara Charny |
First Address | Los Angeles, CA 90035-1613 |
Second Address | Los Angeles, CA 90035-1613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2008 |
Last Update Date | 16/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U52395 | (02) | CA |