MEDICARE: PINNACLE NUTRITION CONSULTANTS, 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	:	1780208769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE NUTRITION CONSULTANTS, LLC

Provider Business Mailing Address
First Line	:	10333 HARWIN DR STE 375K
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-1760
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10333 HARWIN DR STE 375K
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-1760
Country	:	US
Telephone Number	:	281-678-5713
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	NALISHA EMEGWKAO
Credential	:	RD
Telephone Number	:	281-678-5713

Provider Enumeration Date	:	06/04/2020
Last Update Date	:	06/04/2020

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