Healthcare Provider Details

I. General information

NPI: 1538826656
Provider Name (Legal Business Name): MEGAN RUFAEL NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4407 AUGUSTA WAY
PERRY HALL MD
21128-8976
US

IV. Provider business mailing address

4407 AUGUSTA WAY
PERRY HALL MD
21128-8976
US

V. Phone/Fax

Practice location:
  • Phone: 949-929-2185
  • Fax:
Mailing address:
  • Phone: 949-929-2185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MEGAN RUFAEL
Title or Position: NUTRITIONIST
Credential: CNS, LDN
Phone: 949-929-2185