Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 32663 | CA |
NPI | 1063834307 |
---|---|
Provider Name | Kaila Hersh |
First Address | San Francisco, CA 94103-4882 |
Second Address | San Francisco, CA 94103-4882 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2014 |
Last Update Date | 06/01/2014 |