Provider Demographics
NPI:1255949616
Name:KRISTIE TOVAR NUTRITION & WELLNESS INC
Entity type:Organization
Organization Name:KRISTIE TOVAR NUTRITION & WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:MOORE
Authorized Official - Last Name:TOVAR
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN
Authorized Official - Phone:818-731-5352
Mailing Address - Street 1:27284 VIA MARCIA
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-1539
Mailing Address - Country:US
Mailing Address - Phone:818-731-5352
Mailing Address - Fax:818-925-3728
Practice Address - Street 1:715 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4262
Practice Address - Country:US
Practice Address - Phone:818-731-5352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2024-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty