MEDICARE: DR. TARA TORRES NUTRITIONIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist
2	133N00000X	Nutritionist	251222	AK

General Provider Information

NPI Number	:	1932777927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TARA TORRES NUTRITIONIST

Provider Business Mailing Address
First Line	:	118 VINTAGE PARK BLVD
Second Line	:	W700
City	:	HOUSTON
State	:	TX
Zip	:	77070-4095
Country	:	US
Telephone Number	:	832-800-3223
Fax Number	:	832-800-3223

Provider Business Practice Location Address
First Line	:	118 VINTAGE PARK BLVD STE W733
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-4095
Country	:	US
Telephone Number	:	832-800-3223
Fax Number	:	832-990-1162

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2021
Last Update Date	:	03/03/2026

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