Healthcare Provider Details

I. General information

NPI: 1043841703
Provider Name (Legal Business Name): FIG NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2020
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4107 N DAMEN AVE APT 37
CHICAGO IL
60618-3258
US

IV. Provider business mailing address

PO BOX 18216
CHICAGO IL
60618-0132
US

V. Phone/Fax

Practice location:
  • Phone: 440-452-5142
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MEGAN GUTIERREZ
Title or Position: REGISTERED DIETITIAN
Credential: MS, RDN, CSR, LDN
Phone: 440-452-5142