Healthcare Provider Details

I. General information

NPI: 1225557630
Provider Name (Legal Business Name): EAT SMART FOR LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 09/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 AIRMOTIVE WAY STE 175
RENO NV
89502-3286
US

IV. Provider business mailing address

316 CALIFONIA AVE #1160
RENO NV
89509
US

V. Phone/Fax

Practice location:
  • Phone: 775-636-4420
  • Fax: 844-879-1888
Mailing address:
  • Phone: 775-636-4420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number32025DI-0
License Number StateNV

VIII. Authorized Official

Name: MR. LYNN MARY REMINGTON
Title or Position: PARTNER OWNER
Credential: PHD RD CDE
Phone: 775-247-3981