Organization
DIABETIC LIFE ACADEMY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BRANDY LYNN MOSLEY (OFFICE MANAGER/COMPLIANCE OFFICER)
(702) 880-9500
Entity
Organization
Contact information
Practice address
4270 S. DECATUR BLVD., SUITE B-1B, LAS VEGAS, NV 89103-6800
(702) 880-9500
(702) 880-9507
Mailing address
4270 S. DECATUR BLVD., SUITE B-1B, LAS VEGAS, NV 89103-6800
(702) 880-9500
(702) 880-9507
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
2061-0219
NV
305S00000X
Point of Service
2061-0219
NV
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
2000394-810
NV
Other
Enumeration date
10/05/2010
Last updated
01/14/2011
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