Provider Demographics
NPI:1386253318
Name:PORRAZZA NUTRITION LLC
Entity type:Organization
Organization Name:PORRAZZA NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORRAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:MDA, RDN, LDN, CPT
Authorized Official - Phone:215-821-7045
Mailing Address - Street 1:1331 EAST LINCOLN HIGHWAY
Mailing Address - Street 2:#216
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19056
Mailing Address - Country:US
Mailing Address - Phone:215-821-7045
Mailing Address - Fax:610-200-5782
Practice Address - Street 1:601 WARWICK RD
Practice Address - Street 2:
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030-3106
Practice Address - Country:US
Practice Address - Phone:215-821-7045
Practice Address - Fax:610-200-5782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-27
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty