Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC31025 | CA |
NPI | 1376794099 |
---|---|
Provider Name | Heather Shott |
First Address | Carlsbad, CA 92008-3146 |
Second Address | Vista, CA 92081-7879 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2008 |
Last Update Date | 01/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC31025 | DC LIC NUMBER (01) | CA |