Provider Demographics
NPI:1245944792
Name:NEXTGEN NUTRITION, LLC
Entity type:Organization
Organization Name:NEXTGEN NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:ELYSE
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:813-486-5547
Mailing Address - Street 1:1770 EVERGREEN ST APT 19
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-1975
Mailing Address - Country:US
Mailing Address - Phone:813-486-5547
Mailing Address - Fax:
Practice Address - Street 1:2108 N ST STE N
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5712
Practice Address - Country:US
Practice Address - Phone:813-486-5547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service