Provider Demographics
NPI:1881139467
Name:SOLASAGE NUTRITION AND DIABETES LLC
Entity type:Organization
Organization Name:SOLASAGE NUTRITION AND DIABETES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KTENIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, CDE
Authorized Official - Phone:281-989-0453
Mailing Address - Street 1:2002 TIMBERLOCH PL
Mailing Address - Street 2:STE 200
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1171
Mailing Address - Country:US
Mailing Address - Phone:281-989-0453
Mailing Address - Fax:
Practice Address - Street 1:2002 TIMBERLOCH PL
Practice Address - Street 2:STE 200
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1171
Practice Address - Country:US
Practice Address - Phone:281-989-0453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80166133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1952636482Medicare PIN