# CLOUDBERRY NUTRITION LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053032292
- **Authorized official:** SUZANNA FAYCURRY (EMPLOYEE)
- **Authorized official phone:** (847) 224-6168

## Contact information

- **Practice address:** 2541 BACK BAY LOOP, COSTA MESA, CA 92627-5421
- **Practice address phone:** (847) 224-6168
- **Mailing address:** 2541 BACK BAY LOOP, COSTA MESA, CA 92627-5421

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133VN1004X | Pediatric Nutrition Registered Dietitian | — | NULL | Yes |
| 133VN1004X | Pediatric Nutrition Registered Dietitian | — | — | Yes |

## Other

- **Enumeration date:** 09/06/2022
- **Last updated:** 09/06/2022