Provider Demographics
NPI:1871209064
Name:INTERSECTED NUTRITION
Entity type:Organization
Organization Name:INTERSECTED NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:N
Authorized Official - Last Name:BUACHARERN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:818-618-4524
Mailing Address - Street 1:7915 COLDWATER CANYON AVE
Mailing Address - Street 2:
Mailing Address - City:N HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-2029
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7915 COLDWATER CANYON AVE
Practice Address - Street 2:
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-2029
Practice Address - Country:US
Practice Address - Phone:818-618-4524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty