1881451953 NPI number — HAVEN HEALTH AND NUTRITION COUNSELING LLC

Table of content: DR. ADELESO ADESINA MD, MA (NPI 1861195604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881451953 NPI number — HAVEN HEALTH AND NUTRITION COUNSELING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAVEN HEALTH AND NUTRITION COUNSELING LLC
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:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881451953
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18047 BEACH BLVD UNIT 8005
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92648-1304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7672 COLGATE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92683-6217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-397-5332
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/05/2024

Additional Information

Authorized Official

Authorized Official Last Name:
GOMEZ
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
REGISTERED DIETITIAN
Authorized Official Telephone Number:
714-397-5332

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)





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