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Organization
VICTOR NUTRITION, LLC
Active
Organization
VICTOR NUTRITION, LLC
Active
Other names
Victor Nutrition Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MADONNA MARIE MAMEROW PHD, RD, LD (OWNER/REGISTERED DIETITIAN)
(281) 469-9668
Entity
Organization
Contact information
Practice address
2600 S SHORE BLVD STE 300, LEAGUE CITY, TX 77573-2944
(281) 436-9668
(281) 402-6286
Mailing address
PO BOX 433, GALVESTON, TX 77553-0433
(281) 436-9668
(833) 259-9548
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
133VN1005X
Renal Nutrition Registered Dietitian
—
—
133VN1006X
Metabolic Nutrition Registered Dietitian
—
—
133VN1101X
Gerontological Nutrition Registered Dietitian
—
—
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
—
—
Other
Enumeration date
11/19/2019
Last updated
01/10/2025
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