Provider Demographics
NPI:1467274795
Name:INSTITUTE FOR FUNCTIONAL HEALTH AND NUTRITION
Entity type:Organization
Organization Name:INSTITUTE FOR FUNCTIONAL HEALTH AND NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:
Authorized Official - Last Name:RANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:818-298-7449
Mailing Address - Street 1:25078 PEACHLAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2558
Mailing Address - Country:US
Mailing Address - Phone:818-298-7449
Mailing Address - Fax:
Practice Address - Street 1:25078 PEACHLAND AVE STE A
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2558
Practice Address - Country:US
Practice Address - Phone:818-298-7449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care