Provider Demographics
NPI:1861181042
Name:DESERT NUTRITION RD, LLC
Entity type:Organization
Organization Name:DESERT NUTRITION RD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:AURORA
Authorized Official - Last Name:URIBE-TANUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-284-1818
Mailing Address - Street 1:43651 DEVYN LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-5858
Mailing Address - Country:US
Mailing Address - Phone:818-284-1818
Mailing Address - Fax:661-760-2428
Practice Address - Street 1:43651 DEVYN LN
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-5858
Practice Address - Country:US
Practice Address - Phone:818-284-1818
Practice Address - Fax:661-760-2428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-03
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty