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General NPI Number Information
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NPI Number | 1588011274
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Entity Type | Organization
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Legal Business Name | WISDOM FOODS INC
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Dates
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Enumeration Date | 05/23/2016
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 16987 ALGONQUIN STREET SUITE L
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649
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Country | US
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Telephone | 714-943-6206
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Fax |
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Provider Business Mailing Address
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Address Line | 16987 ALGONGUIN STREET SUITE L
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649
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Country | US
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Telephone | 714-943-6206
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CLINICAL NUTTRITIONIST
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Name | MRS. CINDY M DIFERDINAND
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Credential | M.S.
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Telephone | 714-943-6206
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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 |
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License Number State |
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