Healthcare Provider Details

I. General information

NPI: 1457091027
Provider Name (Legal Business Name): CARNIVORE LIFESTYLE MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3275 COLLEGE PARK DR
THE WOODLANDS TX
77384-4501
US

IV. Provider business mailing address

3275 COLLEGE PARK DR
THE WOODLANDS TX
77384-4501
US

V. Phone/Fax

Practice location:
  • Phone: 346-220-8063
  • Fax: 832-838-4362
Mailing address:
  • Phone: 346-220-8063
  • Fax: 832-838-4362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE H. NGUYEN
Title or Position: OWNER
Credential: MD
Phone: 346-220-8063