Provider Demographics
NPI:1033930995
Name:KETOGENIC METABOLIC THERAPY LLC DBA TASTE OF KETO
Entity type:Organization
Organization Name:KETOGENIC METABOLIC THERAPY LLC DBA TASTE OF KETO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ HEALTH & WELLNESS COACH
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRGA
Authorized Official - Suffix:
Authorized Official - Credentials:LCHF/KMT
Authorized Official - Phone:520-477-2333
Mailing Address - Street 1:7877 S SUGARBEND DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85757-0076
Mailing Address - Country:US
Mailing Address - Phone:520-477-2333
Mailing Address - Fax:
Practice Address - Street 1:7877 S SUGARBEND DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85757-0076
Practice Address - Country:US
Practice Address - Phone:520-477-2333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty