Healthcare Provider Details

I. General information

NPI: 1972815827
Provider Name (Legal Business Name): MV NUTRITION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 MARKET ST SUITE 324
SAN FRANCISCO CA
94102-2401
US

IV. Provider business mailing address

760 MARKET ST SUITE 324
SAN FRANCISCO CA
94102-2401
US

V. Phone/Fax

Practice location:
  • Phone: 415-398-2102
  • Fax:
Mailing address:
  • Phone: 415-398-2102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number439198
License Number StateCA

VIII. Authorized Official

Name: MANUEL VILLACORTA
Title or Position: SOLE PROPRIETOR/REGISTERED DIEITIAN
Credential:
Phone: 415-398-2102