Provider Demographics
NPI:1104690189
Name:HLT NUTRITION CO INC.
Entity type:Organization
Organization Name:HLT NUTRITION CO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNABEL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HUBER
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:760-996-4717
Mailing Address - Street 1:461 W G ST
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-2207
Mailing Address - Country:US
Mailing Address - Phone:760-996-4717
Mailing Address - Fax:888-549-9864
Practice Address - Street 1:605 W H ST STE 116
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-2250
Practice Address - Country:US
Practice Address - Phone:760-996-4717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225457294Medicaid