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DIABETIC LIFE ACADEMY, LLC

Dietary & Nutritional Service Providers Dietitian, Registered

Provider NPI: 1861701062

Organization Information:
Organization Name:  DIABETIC LIFE ACADEMY, LLC
Organization is not Subpart
Authorized Official:  BRANDY LYNN MOSLEY  OFFICE MANAGER/COMPLIANCE OFFICER  702-880-9500

Practice Location:
4270 S. DECATUR BLVD. SUITE B-1B LAS VEGAS, NV 89103-6800 US
Tel: 702-880-9500  Fax: 702-880-9507

Business Mailing Address:
4270 S. DECATUR BLVD. SUITE B-1B LAS VEGAS, NV 89103-6800 US
Tel: 702-880-9500  Fax: 702-880-9507

NPI Information:
NPI: 1861701062
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N133V00000XDietary & Nutritional Service Providers
Dietitian, Registered
NV2061-0219
N305S00000XManaged Care Organizations
Point of Service
NV2061-0219
Y332B00000XSuppliers
Durable Medical Equipment & Medical Supplies
NV2000394-810

Other Provider Identifiers:

IssuerNumberStateType



American Medical Association 2012 taxonomy code information

Code: 332B00000X

Type:

Classification:



Definition:



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