| Doctor Name: | DR. MARY LOUISE LANE-CARLSON |
| NPI Number: | 1508119140 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | EDD, MPH, RD, CDE |
| License Number: | R615454 |
| Business Practice Address: | 16132 Crestline Dr La Mirada, CA - 906383458 |
| Business Phone Number: | 5629475860 |
| Business Fax Number: | |
| Mailing Address: | 16132 Crestline Dr, LA MIRADA |
| State: | CA |
| Postal Code: | 906383458 |
| Phone Number: | 5629475860 |
| Fax Number: | |
| NPI Enumeration Date: | 10/19/2012 |
| NPI Last Update Date: | 10/19/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | R615454 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |