Healthcare Provider Details

I. General information

NPI: 1164344792
Provider Name (Legal Business Name): KUZIARA NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 SPRING ST
SANTA ROSA CA
95404-3902
US

IV. Provider business mailing address

722 SPRING ST
SANTA ROSA CA
95404-3902
US

V. Phone/Fax

Practice location:
  • Phone: 707-293-5398
  • Fax:
Mailing address:
  • Phone: 707-293-5398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: JOHN STANTON KUZIARA
Title or Position: RD
Credential:
Phone: 707-293-5398