Organization
CUSTOM NUTRITION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUCIANA PEREIRA RD (OWNER)
(516) 200-4582
Entity
Organization
Contact information
Practice address
390 PLANDOME RD, MANHASSET, NY 11030-1917
(516) 200-4582
(646) 390-4255
Mailing address
390 PLANDOME RD, MANHASSET, NY 11030-1917
(516) 200-4582
(646) 390-4255
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
09/03/2019
Last updated
09/03/2019
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