Provider Demographics
NPI:1992446181
Name:GOGLIA NUTRITION LLC
Entity type:Organization
Organization Name:GOGLIA NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-449-4857
Mailing Address - Street 1:1220 ROSECRANS ST # 297
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-2674
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2800 28TH ST STE 133
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-6204
Practice Address - Country:US
Practice Address - Phone:619-220-9009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Multi-Specialty