MEDICARE: GBG NUTRITION 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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1396624854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GBG NUTRITION LLC

Provider Business Mailing Address
First Line	:	19172 LONG LAKE RANCH BLVD
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33558-5508
Country	:	US
Telephone Number	:	727-271-0665
Fax Number	:

Provider Business Practice Location Address
First Line	:	19172 LONG LAKE RANCH BLVD
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33558-5508
Country	:	US
Telephone Number	:	727-271-0665
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. ISABEL A QUIJANO
Credential	:	RD
Telephone Number	:	727-271-0665

Provider Enumeration Date	:	08/28/2025
Last Update Date	:	08/28/2025

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Directions to “GBG NUTRITION LLC ” Practice Location

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