JODIE FASULLO RN
NPI 1154885655
Registered Nurse - Nutrition Support in San Clemente, CA

Q: What is Jodie Fasullo's NPI number?

The NPI number for Jodie Fasullo is 1154885655. It was assigned to this individual provider in the NPPES registry on January 29, 2019.

Q: What is Jodie Fasullo's specialty?

The primary specialty registered for this NPI is Registered Nurse, specializing in Nutrition Support, with taxonomy code 163WN1003X.

Q: When was this NPI record last updated?

The NPPES record for Jodie Fasullo was last updated on January 29, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since January 29, 2019

37 OPTIMA, SAN CLEMENTE, CA 92672(949) 813-3026 Get Directions Write a Review

NPPES record last updated: January 29, 2019. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Jodie Fasullo Rn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JODIE FASULLO RN (NPI 1154885655) is an individual nutrition support provider in San Clemente, California, licensed in California (718632) and active in the NPI registry since January 2019. She maintains a secondary practice location in Lake Forest.

NPPES Registry Identity

NPI1154885655

Entity TypeIndividualFemale

Primary Taxonomy163WN1003X

Provider Legal NameJODIE FASULLOCredential: RN

Location Address37 OPTIMASan Clemente, CA 92672-9407

Mailing Address37 OptimaSan Clemente, CA 92672-9407 · (949) 813-3026

Phone(949) 813-3026

Sole ProprietorYes

Enumeration DateJanuary 29, 2019

✔ NPI 1154885655 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyRegistered Nurse · Nutrition SupportNursing Service Providers

Taxonomy Code163WN1003X

License✔ Licensed in CA · 718632

37 OPTIMA, San Clemente, CA 92672

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Secondary Practice Location 1

Location 122600 Lambert St Ste 802BLake Forest, CA 92630-1620 · Phone (949) 813-3026

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jodie Fasullo's NPI number?

The NPI number for Jodie Fasullo is 1154885655. It was assigned to this individual provider in the NPPES registry on January 29, 2019.

Where is Jodie Fasullo located?

Jodie Fasullo practices at 37 Optima, San Clemente, CA 92672. The listed phone number is (949) 813-3026.

What is Jodie Fasullo's specialty?

The primary specialty registered for this NPI is Registered Nurse, specializing in Nutrition Support, with taxonomy code 163WN1003X.

When was this NPI record last updated?

The NPPES record for Jodie Fasullo was last updated on January 29, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.