Healthcare Provider Details

I. General information

NPI: 1407977994
Provider Name (Legal Business Name): CHRISTINA LAZZARETTO RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1489 CHESTNUT ST
SAN FRANCISCO CA
94123-3115
US

IV. Provider business mailing address

1489 CHESTNUT ST
SAN FRANCISCO CA
94123-3115
US

V. Phone/Fax

Practice location:
  • Phone: 415-342-9945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number919118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: