Provider Demographics
NPI:1790258465
Name:BGB NUTRITION INCORPORATED
Entity Type:Organization
Organization Name:BGB NUTRITION INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIANA
Authorized Official - Middle Name:GILBREATH
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-724-6266
Mailing Address - Street 1:PO BOX 1360
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85252-1360
Mailing Address - Country:US
Mailing Address - Phone:832-724-6266
Mailing Address - Fax:
Practice Address - Street 1:6940 E LYRA DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3369
Practice Address - Country:US
Practice Address - Phone:832-724-6266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-05
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty