Provider Demographics
NPI:1699486662
Name:JULIA CHERVINKA NUTRITION THERAPY LLC
Entity type:Organization
Organization Name:JULIA CHERVINKA NUTRITION THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RD
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERVINKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-816-7324
Mailing Address - Street 1:15926 MIDLAND VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-6108
Mailing Address - Country:US
Mailing Address - Phone:503-816-7324
Mailing Address - Fax:
Practice Address - Street 1:15926 MIDLAND VALLEY WAY
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-6108
Practice Address - Country:US
Practice Address - Phone:503-816-7324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service