Healthcare Provider Details

I. General information

NPI: 1679260095
Provider Name (Legal Business Name): GOOD NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3643 W HEMLOCK ST
OXNARD CA
93035-3115
US

IV. Provider business mailing address

3643 W HEMLOCK ST
OXNARD CA
93035-3115
US

V. Phone/Fax

Practice location:
  • Phone: 805-718-5076
  • Fax:
Mailing address:
  • Phone: 805-718-5076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: DIURKA SOTOMAYOR
Title or Position: OWNER
Credential:
Phone: 786-419-8926