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General NPI Number Information
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NPI Number | 1164048757
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Entity Type | Organization
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Legal Business Name | SOCAL NUTRITIONISTS LLC
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Dates
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Enumeration Date | 06/19/2020
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Last Update Date | 02/07/2022
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Provider Practice Location Address
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Address Line | 720 W 30TH ST
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City | SAN PEDRO
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State | CA
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Zip | 90731
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Country | US
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Telephone | 310-395-7973
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Fax |
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Provider Business Mailing Address
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Address Line | 720 W 30TH ST
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City | SAN PEDRO
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State | CA
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Zip | 90731-6616
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Country | US
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Telephone | 424-280-6110
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SAIRA G TORRES
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Credential | RDN
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Telephone | 424-280-6110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1005X
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Taxonomy Name | Renal Nutrition Registered Dietitian
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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 | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 133VN1501X
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Taxonomy Name | Sports Dietetics Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #5
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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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