NPIMap

Organization Active NPI

Nutrible Inc

  • Registered Dietitian
  • Irvine, CA
National Provider Identifier
1619606571
Registry record updated Oct 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Legal business name
NUTRIBLE INC
Practice address
2416 Spectrum
Irvine, CA 92618-3138
Phone
(708) 502-2828
NPI assigned
Jun 7, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2022

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

Authorized official

Name
Kwamane Liddell, JD, RN
Title
Ceo
Phone
(708) 502-2828

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133V00000X Primary
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

2416 Spectrum
Irvine, CA 92618-3138

Mailing address

2416 Spectrum
Irvine, CA 92618-3138
Phone (708) 502-2828

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1654560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665014400000",
    "number": "1619606571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2416 SPECTRUM",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926183138",
            "telephone_number": "708-502-2828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2416 SPECTRUM",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926183138",
            "telephone_number": "708-502-2828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NUTRIBLE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-07",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A",
        "authorized_official_last_name": "LIDDELL",
        "authorized_official_first_name": "KWAMANE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "708-502-2828",
        "authorized_official_credential": "JD, RN"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Irvine, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 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.