Provider Demographics
NPI:1194583393
Name:ZAMZAM NUTRITION LLC
Entity type:Organization
Organization Name:ZAMZAM NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMZAM
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:909-747-4353
Mailing Address - Street 1:1124 ALASKA DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-7720
Mailing Address - Country:US
Mailing Address - Phone:909-747-4353
Mailing Address - Fax:
Practice Address - Street 1:1124 ALASKA DR
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-7720
Practice Address - Country:US
Practice Address - Phone:909-747-4353
Practice Address - Fax:972-692-8541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty