Provider Demographics
NPI:1023881794
Name:NUTRI-MED RX LLC
Entity type:Organization
Organization Name:NUTRI-MED RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DESTINY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:805-312-5796
Mailing Address - Street 1:4605 LA TUNA CT
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-4035
Mailing Address - Country:US
Mailing Address - Phone:805-312-5796
Mailing Address - Fax:805-764-8601
Practice Address - Street 1:4605 LA TUNA CT
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-4035
Practice Address - Country:US
Practice Address - Phone:805-312-5796
Practice Address - Fax:805-764-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-03
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty