MEDICARE: NUTRITION PLUS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1201X	Obesity and Weight Management Nutrition Registered Dietitian
2	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1336789932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUTRITION PLUS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 925
Second Line	:
City	:	COLUMBUS
State	:	TX
Zip	:	78934-0925
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1818 W US HIGHWAY 90
Second Line	:
City	:	SCHULENBURG
State	:	TX
Zip	:	78956-5304
Country	:	US
Telephone Number	:	979-702-8752
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VIOLETA MANZANO
Credential	:	MS, RDN
Telephone Number	:	979-702-8752

Provider Enumeration Date	:	01/10/2020
Last Update Date	:	01/10/2020

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Directions to “NUTRITION PLUS, LLC ” Practice Location

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