Healthcare Provider Details

I. General information

NPI: 1265096465
Provider Name (Legal Business Name): NATALIA ULLRICH REGISTERED DIETITIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19722 MACARTHUR BLVD
IRVINE CA
92612-2404
US

IV. Provider business mailing address

12455 S DAVIES PL
TUSTIN CA
92782-1198
US

V. Phone/Fax

Practice location:
  • Phone: 949-824-4764
  • Fax:
Mailing address:
  • Phone: 657-335-7978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: