Organization
NUTRITION THERAPY NEW MEXICO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY PATRICIA WILLMS RD (CEO/MEDICAL DIRECTOR)
(505) 412-5983
Entity
Organization
Contact information
Practice address
2185 44TH ST, STE D, LOS ALAMOS, NM 87544-1750
(505) 412-5983
Mailing address
2185 44TH ST, STE D, LOS ALAMOS, NM 87544-1750
(505) 412-5983
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD-0659
NM
Other
Enumeration date
10/01/2014
Last updated
04/15/2015
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