Provider Demographics
NPI:1245464635
Name:YOUR WHOLE BODY NUTRITION, LLC
Entity type:Organization
Organization Name:YOUR WHOLE BODY NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:480-258-3653
Mailing Address - Street 1:3930 S ALMA SCHOOL RD STE 8
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-4510
Mailing Address - Country:US
Mailing Address - Phone:480-258-3653
Mailing Address - Fax:480-883-3209
Practice Address - Street 1:3930 S ALMA SCHOOL RD STE 8
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-4510
Practice Address - Country:US
Practice Address - Phone:480-258-3653
Practice Address - Fax:480-883-3209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty