Provider Demographics
NPI:1710544275
Name:NOURISH, INC.
Entity Type:Organization
Organization Name:NOURISH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN,CEO, PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:VAUGHNES
Authorized Official - Last Name:DUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:831-359-0675
Mailing Address - Street 1:NOURISH
Mailing Address - Street 2:130 WALNUT AVENUE
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3835
Mailing Address - Country:US
Mailing Address - Phone:831-359-5335
Mailing Address - Fax:866-731-7132
Practice Address - Street 1:NOURISH
Practice Address - Street 2:130 WALNUT AVENUE
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3835
Practice Address - Country:US
Practice Address - Phone:831-359-5335
Practice Address - Fax:866-731-7132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty