Provider Demographics
NPI:1235820226
Name:INSIGHTFUL NUTRITION AND WELLNESS
Entity Type:Organization
Organization Name:INSIGHTFUL NUTRITION AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BESSONOVA
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, CDN, CDCES
Authorized Official - Phone:212-470-2735
Mailing Address - Street 1:327 AVENIDA LA CUESTA
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4208
Mailing Address - Country:US
Mailing Address - Phone:212-470-2735
Mailing Address - Fax:
Practice Address - Street 1:327 AVENIDA LA CUESTA
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4208
Practice Address - Country:US
Practice Address - Phone:212-470-2735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty