Organization Name: | FIRST STEP NUTRITION THERAPY |
NPI Number: | 1083010581 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BROOKE KUGLER ASCHIDAMINI (REGISTERED DIETITIAN) |
Mailing Address: | 624 W 9th St #103 San Pedro |
State: | CA US |
Postal Code: | 907313158 |
Phone Number: | 3109384575 |
Fax Number: | |
NPI Enumeration Date: | 11/10/2014 |
NPI Last Update Date: | 11/12/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QH0100X |
License Number: | RDN REG. #1093633 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Health Service |
Taxonomy Definition: |