Organization Name: | NUTRITION THERAPY NEW MEXICO LLC |
NPI Number: | 1710380910 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARY PATRICIA WILLMS (CEO/MEDICAL DIRECTOR) |
Mailing Address: | 2185 44th St Ste D Los Alamos |
State: | NM US |
Postal Code: | 875441750 |
Phone Number: | 5054125983 |
Fax Number: | |
NPI Enumeration Date: | 10/01/2014 |
NPI Last Update Date: | 04/15/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133V00000X |
License Number: | LD-0659 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | |
Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |