Healthcare Provider Details

I. General information

NPI: 1396260485
Provider Name (Legal Business Name): NUTRITION CENTER OF COLORADO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7760 E PEAKVIEW AVE APT 211
CENTENNIAL CO
80111-6888
US

IV. Provider business mailing address

7760 E PEAKVIEW AVE APT 211
CENTENNIAL CO
80111-6888
US

V. Phone/Fax

Practice location:
  • Phone: 201-647-0907
  • Fax:
Mailing address:
  • Phone: 201-647-0907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1064421
License Number StateCO

VIII. Authorized Official

Name: CHRISTINE PATORNITI
Title or Position: PRESIDENT
Credential: RD, CDE, MBA
Phone: 201-647-0907