Provider Demographics
NPI:1851012637
Name:NUTRILOGIC, LLC
Entity Type:Organization
Organization Name:NUTRILOGIC, LLC
Other - Org Name:NUTRILOGIC, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANI
Authorized Official - Middle Name:
Authorized Official - Last Name:EL DADA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:214-216-2809
Mailing Address - Street 1:888 S GREENVILLE AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5044
Mailing Address - Country:US
Mailing Address - Phone:214-216-2809
Mailing Address - Fax:945-468-7340
Practice Address - Street 1:888 S GREENVILLE AVE STE 304
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5044
Practice Address - Country:US
Practice Address - Phone:718-314-5528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-08
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty