Provider Demographics
NPI:1356114482
Name:NUTRIPATH WELLNESS LLC
Entity type:Organization
Organization Name:NUTRIPATH WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:MORAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERMESH
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:818-802-2434
Mailing Address - Street 1:2002 4TH ST APT 106
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-1132
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23123 VENTURA BLVD STE 203
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1172
Practice Address - Country:US
Practice Address - Phone:818-802-2434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty