Healthcare Provider Details

I. General information

NPI: 1427675818
Provider Name (Legal Business Name): COMPLETE NUTRITION SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2806 SANTA OLIVIA ST
MISSION TX
78572-7615
US

IV. Provider business mailing address

PO BOX 5403
MISSION TX
78573-0093
US

V. Phone/Fax

Practice location:
  • Phone: 956-600-4473
  • Fax:
Mailing address:
  • Phone: 956-600-4473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: ANA D ESCRIVAN
Title or Position: MANAGING MEMBER
Credential: RD
Phone: 956-600-4473