Provider Demographics
NPI:1326250069
Name:NUTRILIFE WELLNESS INC.
Entity Type:Organization
Organization Name:NUTRILIFE WELLNESS INC.
Other - Org Name:LLR CONSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:RAMIREZ
Authorized Official - Last Name:MARCUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MS RD, LD
Authorized Official - Phone:832-453-5336
Mailing Address - Street 1:PO BOX 11945
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77391-1945
Mailing Address - Country:US
Mailing Address - Phone:832-453-5336
Mailing Address - Fax:
Practice Address - Street 1:9950 CYPRESSWOOD DR
Practice Address - Street 2:SUITE 205
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-3414
Practice Address - Country:US
Practice Address - Phone:832-453-5336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06387133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612609Medicare ID - Type Unspecified