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General NPI Number Information
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NPI Number | 1619852449
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Entity Type | Individual
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Provider Name | LAURIE GOTTLIEB
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Gender | Female
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Dates
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Enumeration Date | 08/11/2025
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 85 BOLINAS RD STE 5
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City | FAIRFAX
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State | CA
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Zip | 94930-1626
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Country | US
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Telephone | 415-760-6108
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Fax | 888-226-7020
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Provider Business Mailing Address
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Address Line | 159 W OAK KNOLL DR
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City | SAN ANSELMO
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State | CA
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Zip | 94960-1175
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Country | US
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Telephone | 415-760-6108
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Fax | 415-760-6108
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State | CA
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