Provider Demographics
NPI:1033629175
Name:360 NUTRITION CONSULTING INC
Entity Type:Organization
Organization Name:360 NUTRITION CONSULTING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELSEA
Authorized Official - Middle Name:JOHANNA
Authorized Official - Last Name:CREGUT
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:805-738-5700
Mailing Address - Street 1:400 MOBIL AVE STE D9
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-6376
Mailing Address - Country:US
Mailing Address - Phone:805-738-5700
Mailing Address - Fax:805-830-1735
Practice Address - Street 1:400 MOBIL AVE STE D9
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6376
Practice Address - Country:US
Practice Address - Phone:805-738-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty