Healthcare Provider Details

I. General information

NPI: 1699368860
Provider Name (Legal Business Name): STARBERRIE NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 39TH AVE
SAN FRANCISCO CA
94116-2153
US

IV. Provider business mailing address

2460 39TH AVE
SAN FRANCISCO CA
94116-2153
US

V. Phone/Fax

Practice location:
  • Phone: 818-293-7367
  • Fax:
Mailing address:
  • Phone: 818-293-7367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: LILLIE NGUYEN
Title or Position: OWNER/CEO
Credential: DCN, CNS, LDN
Phone: 818-293-7367