Provider Demographics
NPI:1295469229
Name:FRESH & FABULOUS, INC.
Entity type:Organization
Organization Name:FRESH & FABULOUS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAGDA
Authorized Official - Middle Name:ADEL
Authorized Official - Last Name:WEYDT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:805-486-4547
Mailing Address - Street 1:11946 MAPLE CREST ST
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-3170
Mailing Address - Country:US
Mailing Address - Phone:818-216-8853
Mailing Address - Fax:
Practice Address - Street 1:115 DAWSON DR
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8003
Practice Address - Country:US
Practice Address - Phone:818-216-8853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-14
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No174200000XOther Service ProvidersMealsGroup - Single Specialty