Provider Demographics
NPI:1225647225
Name:NALLY, LILLIE LOURDES (MS, RDN)
Entity Type:Individual
Prefix:
First Name:LILLIE
Middle Name:LOURDES
Last Name:NALLY
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41542 51ST ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-2576
Mailing Address - Country:US
Mailing Address - Phone:661-794-3215
Mailing Address - Fax:
Practice Address - Street 1:41542 51ST ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-2576
Practice Address - Country:US
Practice Address - Phone:661-794-3215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-26
Last Update Date:2020-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86102555133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered