Healthcare Provider Details

I. General information

NPI: 1427836592
Provider Name (Legal Business Name): RM WELLNESS DIETITIANS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2127 OLYMPIC PKWY STE 1006-645
CHULA VISTA CA
91915-1359
US

IV. Provider business mailing address

2211 E ORANGEWOOD AVE UNIT 348
ANAHEIM CA
92806-6529
US

V. Phone/Fax

Practice location:
  • Phone: 619-250-0142
  • Fax:
Mailing address:
  • Phone: 619-250-0142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name: MINERVA BALLESTEROS
Title or Position: PRESIDENT
Credential: RD
Phone: 619-250-0142