# PEDIATRIC NUTRITION OF SOUTHERN NEVADA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578380333
- **Authorized official:** ADAM CISEK RD (REGISTERED DIETITIAN)
- **Authorized official phone:** (702) 813-4318

## Contact information

- **Practice address:** 3148 ECKING AVE, HENDERSON, NV 89044-0291
- **Practice address phone:** (702) 813-4318
- **Mailing address:** 401 RYLAND ST STE 200A, RENO, NV 89502-1643
- **Mailing address phone:** (702) 813-4318

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133VN1004X | Pediatric Nutrition Registered Dietitian | — | NULL | Yes |
| 133VN1004X | Pediatric Nutrition Registered Dietitian | — | — | Yes |

## Other

- **Enumeration date:** 09/23/2024
- **Last updated:** 09/23/2024