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General NPI Number Information
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NPI Number | 1871431312
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Entity Type | Organization
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Legal Business Name | CALIFORNIA CLINICAL NUTRITION SERVICES LLC
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Dates
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Enumeration Date | 03/24/2026
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Last Update Date | 03/24/2026
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Provider Practice Location Address
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Address Line | 1309 W MISSION BLVD UNIT 50
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City | ONTARIO
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State | CA
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Zip | 91762-6845
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Country | US
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Telephone | 951-691-0933
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Fax |
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Provider Business Mailing Address
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Address Line | 19207 AMBER VALLEY DR
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City | WALNUT
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State | CA
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Zip | 91789-4505
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE JIN
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Credential |
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Telephone | 951-691-0933
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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 |
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