Provider Demographics
NPI:1336801844
Name:MY RD NUTRITION SERVICES LLC
Entity Type:Organization
Organization Name:MY RD NUTRITION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RD,LD
Authorized Official - Phone:956-655-8007
Mailing Address - Street 1:214 N 16TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-7984
Mailing Address - Country:US
Mailing Address - Phone:956-655-8007
Mailing Address - Fax:
Practice Address - Street 1:214 N 16TH ST STE 125
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-7984
Practice Address - Country:US
Practice Address - Phone:956-655-8007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty