Provider Demographics
NPI:1134000805
Name:THENUTRIBLOOM
Entity type:Organization
Organization Name:THENUTRIBLOOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CORALIA
Authorized Official - Last Name:BRIONES ORMAZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-632-6164
Mailing Address - Street 1:3035 BETTINA WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-4261
Mailing Address - Country:US
Mailing Address - Phone:415-632-6164
Mailing Address - Fax:
Practice Address - Street 1:3035 BETTINA WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-4261
Practice Address - Country:US
Practice Address - Phone:415-632-6164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty