| NPI | 1104495431 |
|---|---|
| Former Legal Business Name | REALISTIC ROOTS COUNSELING |
| Entity Type | Organization |
| Authorized Contact | TIANNA NOELLE NILSEN Owner/Dietitian 760-716-1274 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2025-09-03 |