Provider Demographics
NPI:1023654670
Name:VICTOR NUTRITION, LLC
Entity type:Organization
Organization Name:VICTOR NUTRITION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/REGISTERED DIETITIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MADONNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MAMEROW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RD, LD
Authorized Official - Phone:281-469-9668
Mailing Address - Street 1:PO BOX 433
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77553-0433
Mailing Address - Country:US
Mailing Address - Phone:281-436-9668
Mailing Address - Fax:833-259-9548
Practice Address - Street 1:2600 S SHORE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2944
Practice Address - Country:US
Practice Address - Phone:281-436-9668
Practice Address - Fax:281-402-6286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Multi-Specialty
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Multi-Specialty
No133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, GerontologicalGroup - Multi-Specialty
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Multi-Specialty