1144136078 NPI number — NOURISHED RD INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144136078 NPI number — NOURISHED RD INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NOURISHED RD INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144136078
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1286 UNIVERSITY AVE STE 1062
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92103-3312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-383-7137
Provider Business Mailing Address Fax Number:
617-613-7288

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3775 SIXTH AVE
Provider Second Line Business Practice Location Address:
#605
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-3312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-383-7137
Provider Business Practice Location Address Fax Number:
617-613-7288
Provider Enumeration Date:
08/20/2026

Additional Information

Authorized Official

Authorized Official Last Name:
BOKAT
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
SUZANNE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
240-687-1703

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com