Provider Demographics
NPI:1154635621
Name:DUBOSE & ASSOCIATES NUTRITION MANAGEMENT COMPANY
Entity Type:Organization
Organization Name:DUBOSE & ASSOCIATES NUTRITION MANAGEMENT COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATRENIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUBOSE
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD/N
Authorized Official - Phone:941-376-6060
Mailing Address - Street 1:5104 N LOCKWOOD RIDGE RD
Mailing Address - Street 2:SUITE 104-A
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34234-3311
Mailing Address - Country:US
Mailing Address - Phone:941-360-0505
Mailing Address - Fax:941-360-6767
Practice Address - Street 1:5104 N LOCKWOOD RIDGE RD
Practice Address - Street 2:SUITE 104-A
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-3311
Practice Address - Country:US
Practice Address - Phone:941-360-0505
Practice Address - Fax:941-360-6767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2921/847957133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty