Healthcare Provider Details

I. General information

NPI: 1245944792
Provider Name (Legal Business Name): NEXTGEN NUTRITION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 01/10/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 N ST STE N
SACRAMENTO CA
95816-5712
US

IV. Provider business mailing address

1770 EVERGREEN ST APT 19
SAN DIEGO CA
92106-1975
US

V. Phone/Fax

Practice location:
  • Phone: 813-486-5547
  • Fax:
Mailing address:
  • Phone: 813-486-5547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BROOKE ELYSE ROBINSON
Title or Position: OWNER/DIETITIAN
Credential: MS, RD
Phone: 813-486-5547