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General NPI Number Information
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NPI Number | 1306774567
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Entity Type | Organization
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Legal Business Name | IRIS NUTRITION, LLC
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Dates
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Enumeration Date | 05/09/2026
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Last Update Date | 05/09/2026
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Provider Practice Location Address
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Address Line | 110 PROSPECT ST FL 2
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City | LODI
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State | NJ
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Zip | 07644-2335
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Country | US
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Telephone | 650-518-0820
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Fax |
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Provider Business Mailing Address
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Address Line | 110 PROSPECT ST FL 2
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City | LODI
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State | NJ
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Zip | 07644-2335
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Country | US
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Telephone | 650-518-0820
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | MISS ANNE CORONADO
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Credential | RD
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Telephone | 650-518-0820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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