Healthcare Provider Details

I. General information

NPI: 1316445380
Provider Name (Legal Business Name): ALL-IN-ONE NUTRITION CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 N CEDAR ST
SUMMERVILLE SC
29483-6606
US

IV. Provider business mailing address

277 PEMBERLY BLVD
SUMMERVILLE SC
29486-7780
US

V. Phone/Fax

Practice location:
  • Phone: 201-566-0120
  • Fax:
Mailing address:
  • Phone:
  • 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: ALEXANDRA GUMEN
Title or Position: OWNER
Credential: RDN
Phone: 201-566-0120