Organization
AG NUTRITION SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON GRAVES MS, RD, CNSC (OWNER)
(626) 768-8331
Entity
Organization
Contact information
Practice address
1245 WILSHIRE BLVD, SUITE 305, LOS ANGELES, CA 90017-4810
(626) 768-8331
Mailing address
301 N HUDSON AVE, UNIT A, PASADENA, CA 91101-1634
(626) 768-8331
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
925528
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1467626135
MEDICARE NPI
CA
Enumeration date
09/30/2008
Last updated
07/08/2009
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