Provider Demographics
NPI:1083010581
Name:FIRST STEP NUTRITION THERAPY
Entity Type:Organization
Organization Name:FIRST STEP NUTRITION THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:KUGLER
Authorized Official - Last Name:ASCHIDAMINI
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, CISSN
Authorized Official - Phone:727-688-9584
Mailing Address - Street 1:1401 N GREENBRIER RD
Mailing Address - Street 2:#104
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-3900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:624 W 9TH ST
Practice Address - Street 2:#103
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3158
Practice Address - Country:US
Practice Address - Phone:310-938-4575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDN REG. #1093633261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service