Provider Demographics
NPI:1497239768
Name:NUTRITION LINK
Entity Type:Organization
Organization Name:NUTRITION LINK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CYNTHIA
Authorized Official - Last Name:MOLENO
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:323-459-7994
Mailing Address - Street 1:8731 COLBATH AVE
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-3304
Mailing Address - Country:US
Mailing Address - Phone:323-459-7994
Mailing Address - Fax:888-465-7307
Practice Address - Street 1:8731 COLBATH AVE
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-3304
Practice Address - Country:US
Practice Address - Phone:323-459-7994
Practice Address - Fax:888-465-7307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALICENSEOther924712