Healthcare Provider Details

I. General information

NPI: 1124779871
Provider Name (Legal Business Name): NUTRITION COUNSELING WITH AMANDA GEBHART RDN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15555 HUNTINGTON VILLAGE LN APT 26
HUNTINGTON BEACH CA
92647-3044
US

IV. Provider business mailing address

15555 HUNTINGTON VILLAGE LN APT 26
HUNTINGTON BEACH CA
92647-3044
US

V. Phone/Fax

Practice location:
  • Phone: 717-681-7039
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA DARLENE GEBHART
Title or Position: OWNER
Credential: R.D.N.
Phone: 717-681-7039