Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC28717 | CA |
NPI | 1003051319 |
---|---|
Provider Name | Dr. Yvoune Kara Petrie |
First Address | Temecula, CA 92591-1523 |
Second Address | Vienna, VA 22180-4861 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2008 |
Last Update Date | 05/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U95447 | (02) |