Healthcare Provider Details

I. General information

NPI: 1477245728
Provider Name (Legal Business Name): THELANUTRITIONIST INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 RUXTON LN UNIT D
REDONDO BEACH CA
90278-3989
US

IV. Provider business mailing address

1728 RUXTON LN UNIT D
REDONDO BEACH CA
90278-3989
US

V. Phone/Fax

Practice location:
  • Phone: 818-388-3998
  • Fax:
Mailing address:
  • Phone: 818-388-3998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: LAUREN KARP
Title or Position: OWNER
Credential: RDN
Phone: 818-388-3998