Organization
THE SIMPLE LEAF, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRYNA GAVIN CNS (OWNER)
(424) 259-0993
Entity
Organization
Contact information
Practice address
4824 CRANER AVE APT 214, NORTH HOLLYWOOD, CA 91601-5133
(424) 259-0993
Mailing address
PO BOX 5145, CRESTLINE, CA 92325-5145
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
—
Other
Enumeration date
10/20/2020
Last updated
10/20/2020
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