Provider Demographics
NPI:1598429227
Name:MARIA LIFESTYLE NUTRITION PLLC
Entity Type:Organization
Organization Name:MARIA LIFESTYLE NUTRITION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:AGUERO DE MANUNTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-308-0013
Mailing Address - Street 1:38 SUMMERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-1310
Mailing Address - Country:US
Mailing Address - Phone:716-308-0013
Mailing Address - Fax:
Practice Address - Street 1:38 SUMMERVIEW RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-1310
Practice Address - Country:US
Practice Address - Phone:716-308-0013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty