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General NPI Number Information
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NPI Number | 1013101526
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Entity Type | Organization
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Legal Business Name | NUTRI GENOMICS INC
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 08/29/2007
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Provider Practice Location Address
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Address Line | 4201 BEE CAVES RD SUITE B200
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City | AUSTIN
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State | TX
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Zip | 78746
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Country | US
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Telephone | 512-306-1920
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Fax | 512-306-9233
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Provider Business Mailing Address
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Address Line | 4201 BEE CAVES RD SUITE B200
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City | AUSTIN
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State | TX
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Zip | 78746
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Country | US
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Telephone | 512-306-1920
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Fax | 512-306-9233
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Authorized Official
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Title or Position | OPERATING MANAGER
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Name | JAMES EDWARD SHAW
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Credential |
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Telephone | 512-306-1920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | TX
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