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General NPI Number Information
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NPI Number | 1457271546
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Entity Type | Organization
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Legal Business Name | PREVENTIVE NUTRITION FOR LIFE, LLC
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Dates
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Enumeration Date | 07/17/2026
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Last Update Date | 07/17/2026
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Provider Practice Location Address
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Address Line | 1074 VIEJO HILLS DR
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City | LAKE FOREST
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State | CA
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Zip | 92610-3029
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Country | US
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Telephone | 949-436-6182
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Fax |
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Provider Business Mailing Address
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Address Line | 1074 VIEJO HILLS DR
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City | LAKE FOREST
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State | CA
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Zip | 92610-3029
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Country | US
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Telephone | 949-436-6182
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CERISSA ROMAN
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Credential | MPH, RDN
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Telephone | 949-436-6182
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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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