Healthcare Provider Details

I. General information

NPI: 1437810710
Provider Name (Legal Business Name): LAUREN CORNELL NUTRITION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S BARRINGTON AVE STE 103
LOS ANGELES CA
90025-5337
US

IV. Provider business mailing address

1507 7TH ST # 175
SANTA MONICA CA
90401-2605
US

V. Phone/Fax

Practice location:
  • Phone: 424-259-3652
  • Fax: 424-258-9404
Mailing address:
  • Phone: 424-259-3652
  • Fax: 424-258-9404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LAUREN CORNELL
Title or Position: FOUNDER AND CEO
Credential: MS, RDN
Phone: 424-259-3652