Provider Demographics
NPI:1710574322
Name:PRANASPIRIT NUTRITION & WELLNESS, LLC
Entity Type:Organization
Organization Name:PRANASPIRIT NUTRITION & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ILENE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, CDCES
Authorized Official - Phone:917-658-0554
Mailing Address - Street 1:2219 MAIN ST UNIT 249
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2217
Mailing Address - Country:US
Mailing Address - Phone:888-725-3135
Mailing Address - Fax:877-259-1576
Practice Address - Street 1:2219 MAIN ST UNIT 249
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-2217
Practice Address - Country:US
Practice Address - Phone:888-725-3135
Practice Address - Fax:877-259-1576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty