Healthcare Provider Details

I. General information

NPI: 1730509100
Provider Name (Legal Business Name): KAREN ROTH NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 04/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2436 BAJA CERRO CIR
SAN DIEGO CA
92109-1541
US

IV. Provider business mailing address

2436 BAJA CERRO CIR
SAN DIEGO CA
92109-1541
US

V. Phone/Fax

Practice location:
  • Phone: 818-400-5410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: KAREN ROTH
Title or Position: CERTIFIED NUTRITION CONSULTANT
Credential:
Phone: 818-400-5410