Provider Demographics
NPI:1538749718
Name:NUTRITION SPECIALIST LLC
Entity type:Organization
Organization Name:NUTRITION SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITION SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:CNS
Authorized Official - Phone:786-571-0909
Mailing Address - Street 1:18117 BISCAYNE BLVD # 1176
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2535
Mailing Address - Country:US
Mailing Address - Phone:786-571-0909
Mailing Address - Fax:
Practice Address - Street 1:18117 BISCAYNE BLVD # 1176
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-2535
Practice Address - Country:US
Practice Address - Phone:786-571-0909
Practice Address - Fax:786-661-2804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty