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Organization
BEACH LIFE NUTRITION LLC
Active
Organization
BEACH LIFE NUTRITION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA EDMONDS (RDN)
(904) 608-1068
Entity
Organization
Contact information
Practice address
2920 CAMARILLO LN, VIRGINIA BEACH, VA 23456-1558
(904) 608-1068
Mailing address
2920 CAMARILLO LN, VIRGINIA BEACH, VA 23456-1558
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
818706
CDR REGISTRATION
—
Enumeration date
11/11/2022
Last updated
11/11/2022
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