Provider Demographics
NPI:1124719224
Name:SAMANTHA LALUSH NUTRITION LLC
Entity type:Organization
Organization Name:SAMANTHA LALUSH NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALUSH
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED DIETITIAN
Authorized Official - Phone:805-215-6572
Mailing Address - Street 1:1022 MILL ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2784
Mailing Address - Country:US
Mailing Address - Phone:805-242-6417
Mailing Address - Fax:805-249-1915
Practice Address - Street 1:1022 MILL ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2784
Practice Address - Country:US
Practice Address - Phone:805-242-6417
Practice Address - Fax:805-249-1915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty