Provider Demographics
NPI:1083916399
Name:MY NUTRITION MY LIFE LLC
Entity Type:Organization
Organization Name:MY NUTRITION MY LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMALINI
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:702-606-3106
Mailing Address - Street 1:170 S GREEN VALLEY PKWY FL 3
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-3132
Mailing Address - Country:US
Mailing Address - Phone:702-606-3106
Mailing Address - Fax:702-534-4003
Practice Address - Street 1:170 S GREEN VALLEY PKWY FL 3
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-3132
Practice Address - Country:US
Practice Address - Phone:702-606-3106
Practice Address - Fax:702-534-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20101799454133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty