IndividualActive
Jodie Fasullo, RN
NPI 1154885655 · Nutrition Support Registered Nurse · San Clemente, CA
Provider details
- NPI number
- 1154885655
- Entity type
- Individual
- Primary specialty
- Nutrition Support Registered NurseNursing Service Providers
- Credential
- RN
- Sex
- Female
- Sole proprietor
- Yes
- License
- 718632 (CA)
Mailing address
37 Optima
San Clemente, CA 92672-9407
Registry dates
- Enumerated
- 2019-01-29
- Last updated
- 2019-01-29
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.