Provider Demographics
NPI:1205603784
Name:SOULFLOWER NUTRITION LLC
Entity type:Organization
Organization Name:SOULFLOWER NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MEYLE
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:909-897-3002
Mailing Address - Street 1:440 N BARRANCA AVE # 4623
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1722
Mailing Address - Country:US
Mailing Address - Phone:909-897-3002
Mailing Address - Fax:909-589-1020
Practice Address - Street 1:109 ZERMAT DR # 1389
Practice Address - Street 2:
Practice Address - City:CRESTLINE
Practice Address - State:CA
Practice Address - Zip Code:92325-9391
Practice Address - Country:US
Practice Address - Phone:909-897-3002
Practice Address - Fax:909-589-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty