Healthcare Provider Details

I. General information

NPI: 1851652739
Provider Name (Legal Business Name): NUTRITION AS THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6285 E SPRING ST # 284
LONG BEACH CA
90808-4020
US

IV. Provider business mailing address

6285 E SPRING ST # 284
LONG BEACH CA
90808-4020
US

V. Phone/Fax

Practice location:
  • Phone: 562-424-4055
  • Fax: 949-577-4880
Mailing address:
  • Phone: 562-424-4055
  • Fax: 949-577-4880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number894684
License Number StateCA

VIII. Authorized Official

Name: MS. MAGNOLIA VELA
Title or Position: PRESIDENT
Credential: MS,RD, CDE
Phone: 562-424-4055