Healthcare Provider Details

I. General information

NPI: 1114605961
Provider Name (Legal Business Name): NUTRIWELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5532 LOVERS LN
BROWNSVILLE TX
78526-4284
US

IV. Provider business mailing address

5532 LOVERS LN
BROWNSVILLE TX
78526-4284
US

V. Phone/Fax

Practice location:
  • Phone: 956-455-1767
  • Fax: 956-477-1410
Mailing address:
  • Phone: 956-455-1767
  • Fax: 956-477-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1101X
TaxonomyGerontological Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: AURORA ARACELY CESPEDES MADRIGAL
Title or Position: REGISTERED DIETITIAN
Credential: RDN, LD
Phone: 956-455-5910