Provider Demographics
NPI:1518564830
Name:LALLA, SNEHA (RD)
Entity Type:Individual
Prefix:
First Name:SNEHA
Middle Name:
Last Name:LALLA
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 1:1699 E WASHINGTON ST APT 2234
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-6460
Mailing Address - Country:US
Mailing Address - Phone:239-789-9386
Mailing Address - Fax:
Practice Address - Street 1:4097 TRAIL CREEK RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-5869
Practice Address - Country:US
Practice Address - Phone:239-789-9386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86108226133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered