Healthcare Provider Details

I. General information

NPI: 1497472872
Provider Name (Legal Business Name): GUT HORMONE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 10/26/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 ACORN DR
ANGELS CAMP CA
95222-9806
US

IV. Provider business mailing address

931 10TH ST STE 280
MODESTO CA
95354-2305
US

V. Phone/Fax

Practice location:
  • Phone: 916-642-5747
  • Fax:
Mailing address:
  • Phone: 916-642-5747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: CHELSEA SANFILIPPO
Title or Position: OWNER/CEO/REGISTERED DIETITIAN
Credential: RDN
Phone: 916-642-5747