Provider Demographics
NPI:1063960664
Name:HEALTHY SELFIE, LLC
Entity type:Organization
Organization Name:HEALTHY SELFIE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOU SLEIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, CLT
Authorized Official - Phone:619-200-2165
Mailing Address - Street 1:230 S HOUSER DR
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-3757
Mailing Address - Country:US
Mailing Address - Phone:619-200-2165
Mailing Address - Fax:619-609-0924
Practice Address - Street 1:230 S HOUSER DR
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-3757
Practice Address - Country:US
Practice Address - Phone:619-200-2165
Practice Address - Fax:619-609-0924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA934068133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty