Healthcare Provider Details

I. General information

NPI: 1801193750
Provider Name (Legal Business Name): TOP FUNCTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2011
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18002 FLYNN DR UNIT 6208
CANYON COUNTRY CA
91387-8246
US

IV. Provider business mailing address

18002 FLYNN DR UNIT 6208
CANYON COUNTRY CA
91387-8246
US

V. Phone/Fax

Practice location:
  • Phone: 310-294-4804
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number20091588239
License Number StateNV

VIII. Authorized Official

Name: ELAINE WOODWARD
Title or Position: OWNER AND FOUNDER
Credential:
Phone: 310-294-4804