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General NPI Number Information
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NPI Number | 1194660340
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Entity Type | Organization
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Legal Business Name | DR. B CLINICAL NUTRITION
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Dates
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Enumeration Date | 04/22/2026
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Last Update Date | 04/26/2026
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Provider Practice Location Address
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Address Line | 38 NORTH ST
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City | MACHIAS
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State | ME
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Zip | 04654-1123
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Country | US
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Telephone | 207-271-0309
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Fax |
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Provider Business Mailing Address
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Address Line | 38 NORTH ST
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City | MACHIAS
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State | ME
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Zip | 04654-1123
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Country | US
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Telephone | 207-271-0309
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. GINO BANCAYANVEGA
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Credential | ND MS CNS LDN
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Telephone | 207-271-0309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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