Healthcare Provider Details

I. General information

NPI: 1871315754
Provider Name (Legal Business Name): CONCIERGE NUTRITION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17208 LUVERNE PL
ENCINO CA
91316-3932
US

IV. Provider business mailing address

17208 LUVERNE PL
ENCINO CA
91316-3932
US

V. Phone/Fax

Practice location:
  • Phone: 310-880-9633
  • Fax: 818-975-2178
Mailing address:
  • Phone: 310-880-9633
  • Fax: 818-975-2178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BAHAR MONA SOLASI
Title or Position: OWNER
Credential: RDN
Phone: 310-880-9633