Provider Demographics
NPI:1912663022
Name:WHOLE SELF NUTRITION LLC
Entity Type:Organization
Organization Name:WHOLE SELF NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALIER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-318-6037
Mailing Address - Street 1:3321 CANDELARIA RD NE STE 405B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1971
Mailing Address - Country:US
Mailing Address - Phone:505-289-2300
Mailing Address - Fax:505-715-4426
Practice Address - Street 1:3321 CANDELARIA RD NE STE 405B
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:505-289-2300
Practice Address - Fax:505-715-4426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty