Provider Demographics
NPI:1295080711
Name:LESSER, CAROL R (MS, RD)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:R
Last Name:LESSER
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1983 EVERGLADE AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-2855
Mailing Address - Country:US
Mailing Address - Phone:559-298-4293
Mailing Address - Fax:559-298-2819
Practice Address - Street 1:1983 EVERGLADE AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-2855
Practice Address - Country:US
Practice Address - Phone:559-287-9067
Practice Address - Fax:559-298-2819
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered