Provider Demographics
NPI:1770334310
Name:NUTRITION WITH SZANDRA, LLC
Entity type:Organization
Organization Name:NUTRITION WITH SZANDRA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SZANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLESKA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:757-775-1517
Mailing Address - Street 1:11412 MALAGUENA LN NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-6898
Mailing Address - Country:US
Mailing Address - Phone:757-775-1517
Mailing Address - Fax:
Practice Address - Street 1:3321 CANDELARIA RD NE STE 405
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1971
Practice Address - Country:US
Practice Address - Phone:505-433-1382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty