Provider Demographics
NPI:1710390414
Name:RISA GROUX NUTRITION
Entity Type:Organization
Organization Name:RISA GROUX NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:RISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROUX
Authorized Official - Suffix:
Authorized Official - Credentials:CN
Authorized Official - Phone:949-851-3106
Mailing Address - Street 1:20151 SW BIRCH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1793
Mailing Address - Country:US
Mailing Address - Phone:949-851-3106
Mailing Address - Fax:949-851-5901
Practice Address - Street 1:20151 SW BIRCH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1793
Practice Address - Country:US
Practice Address - Phone:949-851-3106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty