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General NPI Number Information
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NPI Number | 1033629175
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Entity Type | Organization
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Legal Business Name | 360 NUTRITION CONSULTING LLC
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Dates
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Enumeration Date | 10/03/2017
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 400 MOBIL AVE STE D9
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City | CAMARILLO
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State | CA
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Zip | 93010-6376
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Country | US
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Telephone | 805-738-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 400 MOBIL AVE STE D9
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City | CAMARILLO
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State | CA
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Zip | 93010-6376
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Country | US
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Telephone | 805-738-5700
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Fax | 805-830-1735
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Authorized Official
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Title or Position | OWNER
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Name | KELSEA JOHANNA CREGUT
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Credential | RDN
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Telephone | 805-738-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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