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General NPI Number Information
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NPI Number | 1497601298
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Entity Type | Organization
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Legal Business Name | CULTIVATE WELLNESS NUTRITION LLC
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Dates
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Enumeration Date | 03/05/2026
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Last Update Date | 03/05/2026
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Provider Practice Location Address
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Address Line | 3113 VILLA COLONADE DRIVE
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City | LAS VEGAS
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State | NV
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Zip | 89128
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Country | US
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Telephone | 702-623-2263
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Fax |
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Provider Business Mailing Address
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Address Line | 304 S JONES BLVD # 2851
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City | LAS VEGAS
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State | NV
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Zip | 89107-2623
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Country | US
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Telephone |
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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 | JENNY Y LAI
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Credential | RDN
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Telephone | 323-333-1818
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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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