Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC29655 | CA |
NPI | 1417162009 |
---|---|
Provider Name | Crystal Emard |
First Address | Palmdale, CA 93551-1411 |
Second Address | Palmdale, CA 93551-1411 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 18/04/2018 |