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General NPI Number Information
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NPI Number | 1760164198
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Entity Type | Organization
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Legal Business Name | COLORFUL LA VIE NUTRITION, LLC
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Dates
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Enumeration Date | 08/04/2023
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Last Update Date | 08/04/2023
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Provider Practice Location Address
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Address Line | 2700 CEDAR CREEK LN APT 4012
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City | DENTON
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State | TX
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Zip | 76210-2350
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Country | US
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Telephone | 225-240-3409
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 CEDAR CREEK LN APT 4012
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City | DENTON
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State | TX
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Zip | 76210-2350
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Country | US
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Telephone | 225-240-3409
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Fax |
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Authorized Official
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Title or Position | OWNER/REGISTERED DIETITIAN
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Name | MS. CHANTELLE FABRE
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Credential | RDN, LDN
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Telephone | 225-240-3409
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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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