Healthcare Provider Details

I. General information

NPI: 1407774730
Provider Name (Legal Business Name): KARLA MARIE VLIET RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12307 RIATA RD
LOWER LAKE CA
95457-9809
US

IV. Provider business mailing address

12307 RIATA RD
LOWER LAKE CA
95457-9809
US

V. Phone/Fax

Practice location:
  • Phone: 707-995-1817
  • Fax: 707-995-1817
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number727848
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: