Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | B690 | NV |
NPI | 1134668585 |
---|---|
Provider Name | Eric Albert Toranzo |
First Address | Las Vegas, NV 89129-7721 |
Second Address | Las Vegas, NV 89149-4794 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2017 |
Last Update Date | 17/02/2017 |