Most Relevant Information
Provider Data
| NPI Number: | 1003566084 |
| Provider Name: | ISMAEL LABRA HERNANDEZ |
| Entity Type: | Individual |
| Taxonomy Code: | 133NN1002X |
| Specialty: | Nutritionist |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/24/2022 |
| Last Updated: | 03/24/2022 |
Provider Practice Location
1809 NATIONAL AVE
SAN DIEGO
CA
921132113
Practice Location Phone/Fax
| Phone: | 6195152526 |
| Fax: |
Provider Mailing Location
1809 NATIONAL AVE
SAN DIEGO
CA
921132113
Provider Mailing Phone/Fax
| Phone: | 6195152526 |
| Fax: |