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General NPI Number Information
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NPI Number | 1477221307
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Entity Type | Organization
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Legal Business Name | ELITE NUTRITION SERVICES INC.
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Dates
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Enumeration Date | 09/03/2021
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Last Update Date | 03/25/2026
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Provider Practice Location Address
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Address Line | 3610 CENTRAL AVE STE 400
-----------------------------------------------------
City | RIVERSIDE
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State | CA
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Zip | 92506-5907
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Country | US
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Telephone | 951-330-4360
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Fax | 888-978-4430
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Provider Business Mailing Address
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Address Line | PO BOX 858
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City | LAKE ELSINORE
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State | CA
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Zip | 92531-0858
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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 | DIRECTOR/PRESIDENT/TREASURER/SECRET
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Name | MRS. KIMBERLY EDWARDS
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Credential | RDN
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Telephone | 951-330-4360
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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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