Provider Demographics
NPI:1801154042
Name:SOUTHWEST HEALTY LIVING
Entity type:Organization
Organization Name:SOUTHWEST HEALTY LIVING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEARS-OCANAS
Authorized Official - Suffix:
Authorized Official - Credentials:CCN, MS
Authorized Official - Phone:210-471-1127
Mailing Address - Street 1:16350 BLANCO RD. STE. 111
Mailing Address - Street 2:NUTRAWISE
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232
Mailing Address - Country:US
Mailing Address - Phone:210-471-1127
Mailing Address - Fax:210-579-6932
Practice Address - Street 1:16350 BLANCO RD. STE 111
Practice Address - Street 2:NUTRAWISE
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232
Practice Address - Country:US
Practice Address - Phone:210-471-1127
Practice Address - Fax:210-579-6932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty