Provider Demographics
NPI:1578334769
Name:NEWBODY
Entity Type:Organization
Organization Name:NEWBODY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:RD, MPH
Authorized Official - Phone:909-600-2113
Mailing Address - Street 1:2058 N MILLS AVE # 1059
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-2812
Mailing Address - Country:US
Mailing Address - Phone:909-600-2113
Mailing Address - Fax:
Practice Address - Street 1:10365 HERITAGE PARK DR.
Practice Address - Street 2:STE. 101
Practice Address - City:SANTE FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670
Practice Address - Country:US
Practice Address - Phone:909-600-2113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty