Provider Demographics
NPI:1811588015
Name:REAL NUTRITION BY CRYSTAL LLC
Entity Type:Organization
Organization Name:REAL NUTRITION BY CRYSTAL LLC
Other - Org Name:REAL NUTRITION BY CRYSTAL PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LDN, CLT
Authorized Official - Phone:907-727-8613
Mailing Address - Street 1:PO BOX 220224
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99522-0224
Mailing Address - Country:US
Mailing Address - Phone:907-727-8613
Mailing Address - Fax:585-302-2717
Practice Address - Street 1:241 N C ST STE 1F
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-1665
Practice Address - Country:US
Practice Address - Phone:907-727-8613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-30
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty