Provider Demographics
NPI:1811570401
Name:PURE NUTRITION, INC.
Entity Type:Organization
Organization Name:PURE NUTRITION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HSIUNG
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:949-870-7506
Mailing Address - Street 1:830 POLARIS DR
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1720
Mailing Address - Country:US
Mailing Address - Phone:949-870-7506
Mailing Address - Fax:
Practice Address - Street 1:830 POLARIS DR
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-1720
Practice Address - Country:US
Practice Address - Phone:949-870-7506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty