MEDICARE: ALL GOOD 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	:	1770129611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL GOOD NUTRITION LLC

Provider Business Mailing Address
First Line	:	6405 N 6TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126-3806
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6405 N 6TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126-3806
Country	:	US
Telephone Number	:	267-449-5046
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND OWNER
Name	:	MS. ROLDANA HUGANIR
Credential	:
Telephone Number	:	267-449-5046

Provider Enumeration Date	:	11/26/2019
Last Update Date	:	12/13/2019

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Directions to “ALL GOOD NUTRITION LLC ” Practice Location

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