Provider Demographics
NPI:1588397400
Name:NUTRITION COACH RD
Entity type:Organization
Organization Name:NUTRITION COACH RD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:818-732-9995
Mailing Address - Street 1:4960 W WASHINGTON BLVD UNIT 78821
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-6333
Mailing Address - Country:US
Mailing Address - Phone:818-732-9995
Mailing Address - Fax:
Practice Address - Street 1:1890 S COCHRAN AVE APT 18
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-5206
Practice Address - Country:US
Practice Address - Phone:818-732-9995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Single Specialty