Provider Demographics
NPI:1346904059
Name:INTEGRATED NUTRITION CONSULTANTS LLC
Entity Type:Organization
Organization Name:INTEGRATED NUTRITION CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITIONAL OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:MOORE-LIESTER
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CSSD
Authorized Official - Phone:719-684-5754
Mailing Address - Street 1:5950 CANOGA AVE STE 420
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-5037
Mailing Address - Country:US
Mailing Address - Phone:719-684-5754
Mailing Address - Fax:
Practice Address - Street 1:5950 CANOGA AVE STE 420
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-5037
Practice Address - Country:US
Practice Address - Phone:719-684-5754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-28
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty