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General NPI Number Information
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NPI Number | 1770847006
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Entity Type | Organization
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Legal Business Name | WHOLE NEW START, INC
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Dates
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Enumeration Date | 07/02/2012
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Last Update Date | 07/02/2012
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Provider Practice Location Address
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Address Line | 3821 BERRY DR
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City | STUDIO CITY
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State | CA
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Zip | 91604-3858
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Country | US
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Telephone | 310-985-8284
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Fax |
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Provider Business Mailing Address
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Address Line | 3821 BERRY DR
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City | STUDIO CITY
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State | CA
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Zip | 91604-3858
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Country | US
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Telephone | 310-985-8284
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | VICKI NUSSBAUM
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Credential | C.N.
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Telephone | 310-985-8284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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