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General NPI Number Information
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NPI Number | 1295469229
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Entity Type | Organization
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Legal Business Name | FRESH & FABULOUS, INC.
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Dates
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Enumeration Date | 07/14/2022
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Last Update Date | 10/06/2022
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Provider Practice Location Address
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Address Line | 115 DAWSON DR
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City | CAMARILLO
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State | CA
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Zip | 93012-8003
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Country | US
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Telephone | 818-216-8853
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Fax |
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Provider Business Mailing Address
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Address Line | 11946 MAPLE CREST ST
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City | MOORPARK
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State | CA
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Zip | 93021-3170
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Country | US
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Telephone | 818-216-8853
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAGDA ADEL WEYDT
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Credential | MS, RD
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Telephone | 805-486-4547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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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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