Provider Demographics
NPI:1912123100
Name:THE, MARIA ALICE LAGOS (PHD, RD)
Entity type:Individual
Prefix:MRS
First Name:MARIA ALICE
Middle Name:LAGOS
Last Name:THE
Suffix:
Gender:F
Credentials:PHD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10727 ROSEDALE HWY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-3211
Mailing Address - Country:US
Mailing Address - Phone:661-324-1455
Mailing Address - Fax:661-587-5781
Practice Address - Street 1:10727 ROSEDALE HWY
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-3211
Practice Address - Country:US
Practice Address - Phone:661-324-1455
Practice Address - Fax:661-587-5781
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA932687133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered