Provider Demographics
NPI:1558715698
Name:REAL FOOD NUTRITION THERAPY LLC
Entity Type:Organization
Organization Name:REAL FOOD NUTRITION THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DON
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:602-573-9309
Mailing Address - Street 1:6742 E BEVERLY LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5678
Mailing Address - Country:US
Mailing Address - Phone:602-573-9309
Mailing Address - Fax:
Practice Address - Street 1:6742 E BEVERLY LN
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5678
Practice Address - Country:US
Practice Address - Phone:602-573-9309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty