Healthcare Provider Details

I. General information

NPI: 1073424081
Provider Name (Legal Business Name): OC NUTRITION PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 N HARBOR BLVD STE 721
FULLERTON CA
92835-4120
US

IV. Provider business mailing address

1440 N HARBOR BLVD STE 721
FULLERTON CA
92835-4120
US

V. Phone/Fax

Practice location:
  • Phone: 714-869-7174
  • Fax: 833-525-1911
Mailing address:
  • Phone: 714-869-7174
  • Fax: 833-525-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NANCY AHL
Title or Position: OWNER
Credential: RD, CDCES
Phone: 714-869-7174