Provider Demographics
NPI:1962213363
Name:SOCAL NUTRITION & WELLNESS INC
Entity type:Organization
Organization Name:SOCAL NUTRITION & WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:DADA
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, RDN
Authorized Official - Phone:949-478-2288
Mailing Address - Street 1:44 AUVERGNE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT COAST
Mailing Address - State:CA
Mailing Address - Zip Code:92657-1090
Mailing Address - Country:US
Mailing Address - Phone:310-270-8985
Mailing Address - Fax:
Practice Address - Street 1:1100 QUAIL ST STE 111
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2779
Practice Address - Country:US
Practice Address - Phone:949-478-2288
Practice Address - Fax:949-401-6853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty