Healthcare Provider Details

I. General information

NPI: 1790601433
Provider Name (Legal Business Name): GET CLEAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 LEEWARD AVE
SAN MARCOS CA
92078-0925
US

IV. Provider business mailing address

723 LEEWARD AVE
SAN MARCOS CA
92078-0925
US

V. Phone/Fax

Practice location:
  • Phone: 619-709-9232
  • Fax:
Mailing address:
  • Phone: 619-709-9232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: CONNOR DAVID NUTTALL
Title or Position: DIRECTOR /OWNER
Credential:
Phone: 619-709-9232