Healthcare Provider Details

I. General information

NPI: 1508821950
Provider Name (Legal Business Name): XCEL NUTRITION THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 S COAST DR SUITE 257
COSTA MESA CA
92626-7735
US

IV. Provider business mailing address

940 S COAST DR SUITE 257
COSTA MESA CA
92626-7735
US

V. Phone/Fax

Practice location:
  • Phone: 714-432-0380
  • Fax:
Mailing address:
  • Phone: 714-432-0380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberR659610
License Number State

VIII. Authorized Official

Name: MRS. MELANIA BEHRENS
Title or Position: PRESIDENT/CEO
Credential: MA, RD
Phone: 714-432-0380