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General NPI Number Information
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NPI Number | 1669898193
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Entity Type | Organization
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Legal Business Name | LIFESTYLE MEDICINE INSTITUTE LLC
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Dates
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Enumeration Date | 03/07/2014
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Last Update Date | 06/04/2026
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Provider Practice Location Address
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Address Line | 25805 BARTON RD BLDG. A, UNIT 106
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City | LOMA LINDA
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State | CA
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Zip | 92354-3814
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Country | US
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Telephone | 909-796-7676
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Fax | 909-586-9342
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Provider Business Mailing Address
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Address Line | 25805 BARTON RD UNIT 106
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City | LOMA LINDA
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State | CA
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Zip | 92354-3814
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Country | US
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Telephone | 909-796-7676
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Fax | 909-586-9342
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | JUSTINE KUEHN
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Credential |
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Telephone | 408-209-2688
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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 | 01107466
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License Number State | CA
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