Provider Demographics
NPI:1891301479
Name:GENKI NUTRITION
Entity Type:Organization
Organization Name:GENKI NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:VALDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, CSG, CDN, CDCES
Authorized Official - Phone:808-358-4275
Mailing Address - Street 1:2110 30TH AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-4565
Mailing Address - Country:US
Mailing Address - Phone:808-358-4275
Mailing Address - Fax:
Practice Address - Street 1:2110 30TH AVE APT 1
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-4565
Practice Address - Country:US
Practice Address - Phone:808-358-4275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-19
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty