Victor Nutrition, LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

VICTOR NUTRITION, LLC

Doing business as

Victor Nutrition Clinic

Practice address

2600 S Shore Blvd Ste 300
League City, TX 77573-2944

Phone

(281) 436-9668

Fax

(281) 402-6286

NPI assigned

Nov 19, 2019

Last updated

Jan 10, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Madonna Marie Mamerow, PHD, RD, LDNPI 1104488220

Title

Owner/Registered Dietitian

Phone

(281) 469-9668

Specialties & licenses 5

Addresses

Other names 1

• Victor Nutrition Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Madonna M Mamerow, PHD, RDN, LD

  • Registered Dietitian
  • League City, TX
  • NPI 1104488220
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736467200000",
    "number": "1023654670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 433",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775530433",
            "telephone_number": "281-436-9668",
            "fax_number": "833-259-9548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 S SHORE BLVD STE 300",
            "city": "LEAGUE CITY",
            "state": "TX",
            "postal_code": "775732944",
            "telephone_number": "281-436-9668",
            "fax_number": "281-402-6286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTOR NUTRITION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-19",
        "last_updated": "2025-01-10",
        "certification_date": "2025-01-10",
        "status": "A",
        "authorized_official_last_name": "MAMEROW",
        "authorized_official_first_name": "MADONNA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER/REGISTERED DIETITIAN",
        "authorized_official_telephone_number": "281-469-9668",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD, RD, LD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "133VN1005X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Renal",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1006X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1101X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Gerontological",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1201X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Obesity and Weight Management",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Victor Nutrition Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gilda Vasquez, LNFA
• Alfredo J Vazquez, DC
• Mary Cone Veatch, LPA LPC LSOTP
• Aileen Velasquez
• Vivian Le Ventura, PHARMD, RPH
• Victory Lakes Eye Associates
• Victory Lakes Medical Center (First Choice Emergency Room)
• Ana Maria Vidal, MD
• Village Chiropractic and Wellness P.L.L.C. (Cornerstone Chiropractic)
• Village Home Health, L.L.C. (Village Home Health)

• Registered Dietitian in League City, TX
• Providers in League City, TX by specialty
• Registered Dietitian in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.