Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 29571 | CA |
NPI | 1043471410 |
---|---|
Provider Name | Dr. Crystal Whisler |
First Address | Mission Viejo, CA 92691-5502 |
Second Address | Saint Louis, MO 63132-4441 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2008 |
Last Update Date | 03/05/2015 |