Provider Demographics
NPI:1679260095
Name:GOOD NUTRITION LLC
Entity Type:Organization
Organization Name:GOOD NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIURKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTOMAYOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-419-8926
Mailing Address - Street 1:3643 W HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-3115
Mailing Address - Country:US
Mailing Address - Phone:805-718-5076
Mailing Address - Fax:
Practice Address - Street 1:3643 W HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93035-3115
Practice Address - Country:US
Practice Address - Phone:805-718-5076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty