Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 14690 | CA |
NPI | 1083737928 |
---|---|
Provider Name | Gaila Mackenzie-Strawn |
First Address | Escondido, CA 92029-5419 |
Second Address | Escondido, CA 92025-4924 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2007 |
Last Update Date | 08/07/2007 |