Healthcare Provider Details

I. General information

NPI: 1376349944
Provider Name (Legal Business Name): MARIE GABRIELLE LANORIAS EAMIGUEL RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 PESETAS LN
SANTA BARBARA CA
93110-1416
US

IV. Provider business mailing address

133 CALLE VISTA
CAMARILLO CA
93010
US

V. Phone/Fax

Practice location:
  • Phone: 805-681-7658
  • Fax:
Mailing address:
  • Phone: 805-910-0764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86176965
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: