Provider Demographics
NPI:1841024122
Name:NOURISHED & BLOOM LLC
Entity type:Organization
Organization Name:NOURISHED & BLOOM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:DENNISE
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LD
Authorized Official - Phone:956-647-3368
Mailing Address - Street 1:13402 N EXPRESSWAY 281
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542-2433
Mailing Address - Country:US
Mailing Address - Phone:956-647-3368
Mailing Address - Fax:
Practice Address - Street 1:13402 N EXPRESSWAY 281
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78542-2433
Practice Address - Country:US
Practice Address - Phone:956-647-3368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty