Provider Demographics
NPI:1730425976
Name:RGV NUTRITION 4 LIFE LLC
Entity type:Organization
Organization Name:RGV NUTRITION 4 LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ILERETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:RD/LD
Authorized Official - Phone:956-458-0874
Mailing Address - Street 1:4309 N 10TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3008
Mailing Address - Country:US
Mailing Address - Phone:956-630-5433
Mailing Address - Fax:956-630-6389
Practice Address - Street 1:4309 N 10TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3008
Practice Address - Country:US
Practice Address - Phone:956-630-5433
Practice Address - Fax:956-630-6389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80162133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty