NPIMap

Organization Active NPI

Cloudberry Nutrition LLC

  • Pediatric Nutrition Registered Dietitian
  • Costa Mesa, CA
National Provider Identifier
1053032292
Registry record updated Sep 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nutrition Registered DietitianTaxonomy code 133VN1004X
Legal business name
CLOUDBERRY NUTRITION LLC
Practice address
2541 Back Bay Loop
Costa Mesa, CA 92627-5421
Phone
(847) 224-6168
NPI assigned
Sep 6, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Suzanna FaycurryNPI 1578162202
Title
Employee
Phone
(847) 224-6168

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nutrition Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133VN1004X Primary

Addresses

Primary practice location

2541 Back Bay Loop
Costa Mesa, CA 92627-5421

Mailing address

2541 Back Bay Loop
Costa Mesa, CA 92627-5421

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1662422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662422400000",
    "number": "1053032292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2541 BACK BAY LOOP",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926275421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2541 BACK BAY LOOP",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926275421",
            "telephone_number": "847-224-6168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLOUDBERRY NUTRITION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-06",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A",
        "authorized_official_last_name": "FAYCURRY",
        "authorized_official_first_name": "SUZANNA",
        "authorized_official_title_or_position": "EMPLOYEE",
        "authorized_official_telephone_number": "847-224-6168"
    },
    "taxonomies": [
        {
            "code": "133VN1004X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Costa Mesa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.