Provider Demographics
NPI:1316724321
Name:NUTRIBALANCE DIETETICS, LLC
Entity type:Organization
Organization Name:NUTRIBALANCE DIETETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HELMUTH
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, CSR
Authorized Official - Phone:949-636-4907
Mailing Address - Street 1:31976 LAZY GLEN LN
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-3217
Mailing Address - Country:US
Mailing Address - Phone:949-636-4907
Mailing Address - Fax:
Practice Address - Street 1:31976 LAZY GLEN LN
Practice Address - Street 2:
Practice Address - City:TRABUCO CANYON
Practice Address - State:CA
Practice Address - Zip Code:92679-3217
Practice Address - Country:US
Practice Address - Phone:949-636-4907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Single Specialty