MEDICARE: NUTRITION'S MY LIFE 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	:	1700645009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUTRITION'S MY LIFE LLC

Provider Business Mailing Address
First Line	:	8822 N FORK DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78250
Country	:	US
Telephone Number	:	806-239-4426
Fax Number	:

Provider Business Practice Location Address
First Line	:	8822 N FORK DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78250-5240
Country	:	US
Telephone Number	:	806-239-4426
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED DIETITIAN
Name	:	NICOLE EICHINGER
Credential	:	RD
Telephone Number	:	806-239-4426

Provider Enumeration Date	:	03/18/2024
Last Update Date	:	03/18/2024

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