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General NPI Number Information
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NPI Number | 1881544633
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Entity Type | Organization
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Legal Business Name | UPSTREAM WELLNESS
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Dates
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Enumeration Date | 01/31/2026
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Last Update Date | 01/31/2026
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Provider Practice Location Address
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Address Line | 120 MAYFAIR RD
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City | BOULDER CREEK
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State | CA
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Zip | 95006-9401
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Country | US
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Telephone | 831-337-8435
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Fax |
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Provider Business Mailing Address
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Address Line | 120 MAYFAIR RD
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City | BOULDER CREEK
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State | CA
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Zip | 95006-9401
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Country | US
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Telephone | 831-337-8435
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Fax | 831-331-2877
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Authorized Official
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Title or Position | FUNCTIONAL NUTRITIONIST
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Name | MRS. STEPHANIE MICHELLE CARROLL STRUDLEY
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Credential | CNS
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Telephone | 831-337-8435
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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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