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General NPI Number Information
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NPI Number | 1790594562
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Entity Type | Organization
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Legal Business Name | HEALTHY MADE SIMPLE LLC
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 880 SUMMIT DR APT 301
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City | VENTURA
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State | CA
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Zip | 93001-2160
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Country | US
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Telephone | 408-835-6776
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Fax |
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Provider Business Mailing Address
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Address Line | 880 SUMMIT DR APT 301
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City | VENTURA
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State | CA
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Zip | 93001-2160
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Country | US
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Telephone | 408-835-6776
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | DIANA MOUNT
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Credential |
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Telephone | 408-835-6776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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