Organization Active NPI

My Nutrition My Life LLC

  • Registered Dietitian
  • Henderson, NV
National Provider Identifier
1083916399
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
NV20101799454 Issued in NV
Legal business name
MY NUTRITION MY LIFE LLC
Practice address
170 S Green Valley Pkwy FL 3
Henderson, NV 89012-3132
Phone
(702) 606-3106
Fax
(702) 534-4003
NPI assigned
Nov 19, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Kamalini Mukerjee, RDNPI 1427365683
Title
Owner
Phone
(702) 606-3106

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133V00000X NV20101799454 NV Primary

Addresses

Primary practice location

170 S Green Valley Pkwy FL 3
Henderson, NV 89012-3132

Mailing address

170 S Green Valley Pkwy FL 3
Henderson, NV 89012-3132
Phone (702) 606-3106

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110222000680 NV Part B Supplier - Clinic/Group Practice 8325229578 Receives reassigned benefits from 1 practitioner
Practice locations: Henderson, NV

National Provider Directory

National Provider Directory

Locations

170 S Green Valley Pkwy
#3
Henderson, NV 89012

170 S Green Valley Pkwy
Fl 3
Henderson, NV 89012
Phone (702) 606-3106

170 S Green Valley Pkwy
Ste 325
Henderson, NV 89012

170 S Green Valley Pkwy
#325
Henderson, NV 89012

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1290124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1083916399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 S GREEN VALLEY PKWY FL 3",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890123132",
            "telephone_number": "702-606-3106",
            "fax_number": "702-534-4003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 S GREEN VALLEY PKWY FL 3",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890123132",
            "telephone_number": "702-606-3106",
            "fax_number": "702-534-4003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY NUTRITION MY LIFE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-19",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MUKERJEE",
        "authorized_official_first_name": "KAMALINI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-606-3106",
        "authorized_official_credential": "RD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "NV",
            "license": "NV20101799454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.