Provider Demographics
NPI:1376322016
Name:ODYSSEY NUTRITION LLC
Entity type:Organization
Organization Name:ODYSSEY NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORINI
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:707-980-3637
Mailing Address - Street 1:441 ELYSIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:BIG BEAR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92314-9155
Mailing Address - Country:US
Mailing Address - Phone:707-980-3637
Mailing Address - Fax:
Practice Address - Street 1:441 ELYSIAN BLVD
Practice Address - Street 2:
Practice Address - City:BIG BEAR CITY
Practice Address - State:CA
Practice Address - Zip Code:92314-9155
Practice Address - Country:US
Practice Address - Phone:707-980-3637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-22
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty