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NPI Code Detail

MEDICARE: OMEGA HEALTH AND NUTRITION LLC

MEDICARE: OMEGA HEALTH AND NUTRITION LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251K00000XPublic Health or Welfare Agency
2133N00000XNutritionist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134619208
Entity Type Code : Organization
Provider Name (Legal Business Name) : OMEGA HEALTH AND NUTRITION LLC
Provider Business Mailing Address
First Line : 700 N INDIGO TER
Second Line :
City : SAINT JOHNS
State : FL
Zip : 32259-4465
Country : US
Telephone Number : 904-413-3360
Fax Number :
Provider Business Practice Location Address
First Line : 10240 SAN JOSE BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32257-6203
Country : US
Telephone Number : 904-551-1919
Fax Number : 904-306-7839
Authorized Official
Title or Position : DIETICIAN-NUTRITIONIST
Name : MONICA CAROLINA MEDINA-DOBBS
Credential : LDN
Telephone Number : 904-413-3360
Provider Enumeration Date : 05/15/2018
Last Update Date : 04/07/2026

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Directions to “OMEGA HEALTH AND NUTRITION LLC ” Practice Location

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