1205016888 NPI number — YOUR DIETITIAN FOR DIABETES & WEIGHT CONTROL, LLC

Table of content: (NPI 1205016888)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205016888 NPI number — YOUR DIETITIAN FOR DIABETES & WEIGHT CONTROL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOUR DIETITIAN FOR DIABETES & WEIGHT CONTROL, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205016888
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11641 REDWOOD MOUNTAIN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89138-6283
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-525-7703
Provider Business Mailing Address Fax Number:
702-666-8555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7656 W SAHARA AVE STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89117-2773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-525-1105
Provider Business Practice Location Address Fax Number:
702-666-8555
Provider Enumeration Date:
11/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
ANGIE
Authorized Official Middle Name:
DIONE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
702-525-7703

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com