Healthcare Provider Details

I. General information

NPI: 1497677694
Provider Name (Legal Business Name): LACHAEL PROUTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2656 ROSEDALE AVE
SOQUEL CA
95073-2635
US

IV. Provider business mailing address

2656 ROSEDALE AVE
SOQUEL CA
95073-2635
US

V. Phone/Fax

Practice location:
  • Phone: 760-644-1635
  • Fax:
Mailing address:
  • Phone: 760-644-1635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number800129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: