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General NPI Number Information
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NPI Number | 1518551563
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Entity Type | Organization
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Legal Business Name | SKJ NUTRITION LLC
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Dates
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Enumeration Date | 02/21/2021
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Last Update Date | 02/21/2021
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Provider Practice Location Address
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Address Line | 3810 KATELLA AVE
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3302
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Country | US
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Telephone | 714-334-2480
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Fax | 562-598-9527
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Provider Business Mailing Address
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Address Line | 3810 KATELLA AVE
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3302
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Country | US
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Telephone | 714-334-2480
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHRYN HENNING
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Credential | RD
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Telephone | 714-334-2480
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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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