Provider Demographics
NPI:1124888938
Name:THE CULINARY MEDICINE GROUP, LLC
Entity type:Organization
Organization Name:THE CULINARY MEDICINE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:CHARESA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRETT-COLLIN
Authorized Official - Suffix:
Authorized Official - Credentials:NBC-HWC, CNC
Authorized Official - Phone:510-384-1221
Mailing Address - Street 1:1521 SHATTUCK AVE UNIT 9720
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-9060
Mailing Address - Country:US
Mailing Address - Phone:510-384-1221
Mailing Address - Fax:
Practice Address - Street 1:1521 SHATTUCK AVE UNIT 9720
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-9060
Practice Address - Country:US
Practice Address - Phone:510-384-1221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty