Provider Demographics
NPI:1932530771
Name:NUTRIFYI, LLC
Entity Type:Organization
Organization Name:NUTRIFYI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTOINETTA
Authorized Official - Middle Name:V
Authorized Official - Last Name:ANSELMO
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:602-803-4522
Mailing Address - Street 1:544 N ALMA SCHOOL RD
Mailing Address - Street 2:#5
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-5473
Mailing Address - Country:US
Mailing Address - Phone:602-803-4522
Mailing Address - Fax:
Practice Address - Street 1:544 N ALMA SCHOOL RD
Practice Address - Street 2:#5
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5473
Practice Address - Country:US
Practice Address - Phone:602-803-4522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ987208133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty