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General NPI Number Information
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NPI Number | 1487653036
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Entity Type | Organization
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Legal Business Name | DIABETES WELLNESS CENTER, A NURSING CORPORATION
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Dates
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Enumeration Date | 07/16/2005
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 855 4TH ST #2
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City | PISMO BEACH
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State | CA
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Zip | 93449-3102
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Country | US
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Telephone | 805-773-3130
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Fax | 805-773-3120
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Provider Business Mailing Address
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Address Line | 855 4TH ST #2
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City | PISMO BEACH
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State | CA
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Zip | 93449-3102
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Country | US
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Telephone | 805-773-3130
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Fax | 805-773-3120
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Authorized Official
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Title or Position | PRESIDENT
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Name | KRISTINA N DILWORTH
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Credential | RN, MS, FNP
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Telephone | 805-773-3130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number | C2445484
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License Number State | CA
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