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General NPI Number Information
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NPI Number | 1437015260
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Entity Type | Organization
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Legal Business Name | KIND TABLE NUTRITION PLLC
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Dates
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Enumeration Date | 12/24/2025
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Last Update Date | 12/24/2025
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Provider Practice Location Address
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Address Line | 2905 LAKE EAST DR STE 110
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City | LAS VEGAS
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State | NV
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Zip | 89117-2384
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Country | US
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Telephone | 702-742-2477
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Fax |
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Provider Business Mailing Address
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Address Line | 2905 LAKE EAST DR STE 110
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City | LAS VEGAS
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State | NV
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Zip | 89117-2384
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Country | US
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Telephone | 702-742-2477
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | CASSIE MONTANA CEBREROS
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Credential | RDN, LD
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Telephone | 702-742-2477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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