Provider Demographics
NPI:1003052358
Name:LAURA YATVIN NUTRITION SERVICES
Entity Type:Organization
Organization Name:LAURA YATVIN NUTRITION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:YATVIN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:215-455-5370
Mailing Address - Street 1:4231 N. 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140
Mailing Address - Country:US
Mailing Address - Phone:215-455-5370
Mailing Address - Fax:215-455-5374
Practice Address - Street 1:4231 N. 5TH STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140
Practice Address - Country:US
Practice Address - Phone:215-455-5370
Practice Address - Fax:215-455-5374
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LA FORTALEZA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center