Organization
MICHELLE'S BLUE CAROTT GP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELLE PATRICE RIVERA MS RD CDE LD (OWNER)
(281) 682-5967
Entity
Organization
Contact information
Practice address
6419 ALLENTOWN DR, SPRING, TX 77389-3669
(281) 682-5967
Mailing address
6419 ALLENTOWN DR, SPRING, TX 77389-3669
(281) 682-5967
Taxonomy
Speciality
Code
Description
License number
State
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
DT06278
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
610476
MEDICARE PROVIDER NUMBER
TX
Enumeration date
10/10/2007
Last updated
10/10/2007
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