| Up-level Nutrition Coaching, LLC | |
|
226 E Vine St La Grange TX 78945-1658 | |
| (979) 702-8752 | |
| Not Available |
| Full Name | Up-level Nutrition Coaching, LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 226 E Vine St, La Grange, Texas |
| Authorized Official Name and Position | Violeta Martinez (OWNER) |
| Authorized Official Contact | 9797028752 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Up-level Nutrition Coaching, LLC 226 E Vine St La Grange TX 78945-1658 Ph: (979) 702-8752 | Up-level Nutrition Coaching, LLC 226 E Vine St La Grange TX 78945-1658 Ph: (979) 702-8752 |
| NPI Number | 1295455954 |
|---|---|
| Provider Enumeration Date | 08/31/2022 |
| Last Update Date | 08/31/2022 |
| Certification Date | 08/31/2022 |
| Medicare PECOS PAC ID | 8123489507 |
|---|---|
| Medicare Enrollment ID | O20230801004171 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295455954 | NPI | - | NPPES |
| 1952945917 | Other | TX | INDIVIDUAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (NU) | Primary |
| Provider Name | Violeta Martinez |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1952945917 PECOS PAC ID: 6103248554 Enrollment ID: I20200612001251 |
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