Provider Demographics
NPI:1942798491
Name:NUTRITIOUS CONCEPTS LLC
Entity Type:Organization
Organization Name:NUTRITIOUS CONCEPTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:RUBI
Authorized Official - Middle Name:S
Authorized Official - Last Name:ANJUM
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LD
Authorized Official - Phone:972-379-8832
Mailing Address - Street 1:15922 ELDORADO PKWY
Mailing Address - Street 2:STE 500-925
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-8783
Mailing Address - Country:US
Mailing Address - Phone:972-379-8832
Mailing Address - Fax:
Practice Address - Street 1:15922 ELDORADO PKWY
Practice Address - Street 2:STE 500-925
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035
Practice Address - Country:US
Practice Address - Phone:972-379-8832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80546133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty