Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC14679 | CA |
NPI | 1225116338 |
---|---|
Provider Name | Judy F. Lane |
First Address | Calabasas, CA 91372-8188 |
Second Address | Woodland Hills, CA 91364-2900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC14679 | (02) | CA |