Provider Demographics
NPI:1649865445
Name:CORAL NUTRITION COACH, LLC
Entity type:Organization
Organization Name:CORAL NUTRITION COACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:CORAL
Authorized Official - Last Name:ALLENDER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN
Authorized Official - Phone:773-710-2237
Mailing Address - Street 1:5415 S DORCHESTER AVE APT BSMT
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-5328
Mailing Address - Country:US
Mailing Address - Phone:773-710-2237
Mailing Address - Fax:872-244-3810
Practice Address - Street 1:5415 S DORCHESTER AVE APT BSMT
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-5328
Practice Address - Country:US
Practice Address - Phone:773-710-2237
Practice Address - Fax:872-244-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Single Specialty