Provider Demographics
NPI:1144925579
Name:MINDFULLY NOURISHED LIFE
Entity type:Organization
Organization Name:MINDFULLY NOURISHED LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:TODOROVA
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:702-372-8743
Mailing Address - Street 1:9626 BLYTH ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-7220
Mailing Address - Country:US
Mailing Address - Phone:702-372-8743
Mailing Address - Fax:
Practice Address - Street 1:7318 W POST RD STE 211
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-6646
Practice Address - Country:US
Practice Address - Phone:702-815-8111
Practice Address - Fax:702-441-1588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty