Provider Demographics
NPI:1184335267
Name:VIDAWELL NUTRITION CENTER LLC
Entity type:Organization
Organization Name:VIDAWELL NUTRITION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:713-540-0157
Mailing Address - Street 1:7737 SOUTHWEST FWY STE 415
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1800
Mailing Address - Country:US
Mailing Address - Phone:713-988-0653
Mailing Address - Fax:
Practice Address - Street 1:7737 SOUTHWEST FWY STE 415
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1800
Practice Address - Country:US
Practice Address - Phone:713-988-0653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-08
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty