Nutrible Foundation Inc.

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Legal business name

NUTRIBLE FOUNDATION INC.

Practice address

989 S Alice Ave
Rialto, CA 92376-7864

Phone

(562) 516-6500

NPI assigned

Nov 16, 2023

Organization subpart

No

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

Authorized official

Name

Kwamane Liddell, JD, MHA, BSN

Title

Executive Director

Phone

(708) 502-2828

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1700092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700092800000",
    "number": "1942075221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 CENTER AVE APT 333",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926479176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "989 S ALICE AVE",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923767864",
            "telephone_number": "562-516-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NUTRIBLE FOUNDATION INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-16",
        "last_updated": "2023-11-16",
        "certification_date": "2023-11-16",
        "status": "A",
        "authorized_official_last_name": "LIDDELL",
        "authorized_official_first_name": "KWAMANE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "708-502-2828",
        "authorized_official_credential": "JD, MHA, BSN"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community Health Worker in Rialto, CA
• Providers in Rialto, CA by specialty
• Community Health Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2023; 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.