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General NPI Number Information
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NPI Number | 1811570401
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Entity Type | Organization
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Legal Business Name | PURE NUTRITION, INC.
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Dates
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Enumeration Date | 04/30/2021
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 830 POLARIS DR
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City | TUSTIN
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State | CA
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Zip | 92782-1720
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Country | US
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Telephone | 949-870-7506
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Fax |
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Provider Business Mailing Address
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Address Line | 830 POLARIS DR
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City | TUSTIN
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State | CA
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Zip | 92782-1720
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Country | US
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Telephone | 949-870-7506
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EILEEN HSIUNG
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Credential | RDN
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Telephone | 949-870-7506
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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 | NULL
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