Provider Demographics
NPI:1881320604
Name:PERSONALIZED NUTRITION COUNSELING, PC
Entity type:Organization
Organization Name:PERSONALIZED NUTRITION COUNSELING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KASHLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:949-689-5039
Mailing Address - Street 1:1501 LINCOLN BLVD # 1090
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-3503
Mailing Address - Country:US
Mailing Address - Phone:949-689-5039
Mailing Address - Fax:
Practice Address - Street 1:1 VACAVILLE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602
Practice Address - Country:US
Practice Address - Phone:949-689-5039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty