Healthcare Provider Details

I. General information

NPI: 1619406121
Provider Name (Legal Business Name): NUTRITION CARE CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 BEVERLY BLVD
MONTEBELLO CA
90640
US

IV. Provider business mailing address

2605 W BEVERLY BLVD
MONTEBELLO CA
90640-2309
US

V. Phone/Fax

Practice location:
  • Phone: 323-833-2191
  • Fax:
Mailing address:
  • Phone: 323-833-2191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number StateCA

VIII. Authorized Official

Name: PEDRO MONTES DE OCA
Title or Position: BUSINESS PARTNER
Credential: RDN
Phone: 323-833-2191