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General NPI Number Information
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NPI Number | 1356114482
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Entity Type | Organization
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Legal Business Name | NUTRIPATH WELLNESS LLC
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Dates
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Enumeration Date | 10/31/2023
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 23123 VENTURA BLVD STE 203
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-1172
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Country | US
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Telephone | 818-802-2434
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Fax |
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Provider Business Mailing Address
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Address Line | 2002 4TH ST APT 106
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City | SANTA MONICA
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State | CA
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Zip | 90405-1132
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN NUTRITIONIST
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Name | MORAN HERMESH
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Credential | RDN
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Telephone | 818-802-2434
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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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