Provider Demographics
NPI:1134361850
Name:NUTRICIA DIETETICS CONSULTS LLC
Entity type:Organization
Organization Name:NUTRICIA DIETETICS CONSULTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CERRATE-REINOSO
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RD,LD
Authorized Official - Phone:956-664-0026
Mailing Address - Street 1:1400 E. RIDGE RD. STE 6
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1535
Mailing Address - Country:US
Mailing Address - Phone:956-664-0026
Mailing Address - Fax:956-687-3906
Practice Address - Street 1:1400 E RIDGE RD STE 6
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1536
Practice Address - Country:US
Practice Address - Phone:956-664-0026
Practice Address - Fax:956-687-3906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133V00000X133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty