Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC26542 | CA |
NPI | 1275677767 |
---|---|
Provider Name | Supna Chhabra Alis |
First Address | San Juan Capistrano, CA 92675-1582 |
Second Address | San Juan Capistrano, CA 92675-1582 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 08/07/2007 |