Provider Demographics
NPI:1982428751
Name:KARALLI, KRYSTAL MARIE (RD)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:MARIE
Last Name:KARALLI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20500 BELSHAW AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3506
Mailing Address - Country:US
Mailing Address - Phone:855-442-5885
Mailing Address - Fax:
Practice Address - Street 1:20500 BELSHAW AVE
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3506
Practice Address - Country:US
Practice Address - Phone:855-442-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LDN7069133V00000X
MALDN7069133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered