Healthcare Provider Details

I. General information

NPI: 1114599479
Provider Name (Legal Business Name): NUTRICARE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 DIAMOND
IRVINE CA
92620-2143
US

IV. Provider business mailing address

43 DIAMOND
IRVINE CA
92620-2143
US

V. Phone/Fax

Practice location:
  • Phone: 309-370-9931
  • Fax:
Mailing address:
  • Phone: 309-370-9931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: PREETI SONI
Title or Position: OWNER
Credential:
Phone: 309-370-9931