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General NPI Number Information
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NPI Number | 1447147863
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Entity Type | Organization
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Legal Business Name | EBB & FLOW: MEDICAL NUTRITION THERAPY & CONSULTING, LLC
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Dates
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Enumeration Date | 06/19/2025
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 1401 21ST ST STE R
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City | SACRAMENTO
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State | CA
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Zip | 95811-5226
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Country | US
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Telephone | 510-692-7491
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 21ST ST STE R
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City | SACRAMENTO
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State | CA
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Zip | 95811-5226
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Country | US
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Telephone | 510-227-8232
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Fax |
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Authorized Official
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Title or Position | OWNER/FOUNDER
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Name | MISS ASHLEY FORTENBERRY
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Credential | REGISTERED DIETITIAN
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Telephone | 510-692-7491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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