Healthcare Provider Details

I. General information

NPI: 1982225017
Provider Name (Legal Business Name): BARE NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 S TELSHOR BLVD STE 301
LAS CRUCES NM
88011-4757
US

IV. Provider business mailing address

C/O BBP SERVICES LLC 1180 COMMERCE DR SUITE 13880
LAS CRUCES NM
88013-4636
US

V. Phone/Fax

Practice location:
  • Phone: 575-649-0073
  • Fax:
Mailing address:
  • Phone: 575-649-0073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. AMANDA J ESQUIBEL
Title or Position: OWNER
Credential: MS, RD, LD
Phone: 575-649-0073