Provider Demographics
NPI:1083089197
Name:DAILY DIETETICS, LLC
Entity Type:Organization
Organization Name:DAILY DIETETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALISZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LDN
Authorized Official - Phone:804-815-4269
Mailing Address - Street 1:1732 GRAND OVERLOOK ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-4490
Mailing Address - Country:US
Mailing Address - Phone:804-815-4269
Mailing Address - Fax:
Practice Address - Street 1:1732 GRAND OVERLOOK ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-4490
Practice Address - Country:US
Practice Address - Phone:804-815-4269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAILY DIETETICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO961152305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1861775389Medicaid
CO1861775389Medicaid