Provider Demographics
NPI:1366103178
Name:YOUR LIVING HEALTH
Entity type:Organization
Organization Name:YOUR LIVING HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:LUCCHESI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-306-5312
Mailing Address - Street 1:PO BOX 439
Mailing Address - Street 2:
Mailing Address - City:TUOLUMNE
Mailing Address - State:CA
Mailing Address - Zip Code:95379-0439
Mailing Address - Country:US
Mailing Address - Phone:530-306-5312
Mailing Address - Fax:844-413-7182
Practice Address - Street 1:211 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5025
Practice Address - Country:US
Practice Address - Phone:530-306-5312
Practice Address - Fax:844-413-7182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center