Healthcare Provider Details

I. General information

NPI: 1598955056
Provider Name (Legal Business Name): NURTURE LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E COLORADO ST INSIDE WORLD GYM
GLENDALE CA
91205-1225
US

IV. Provider business mailing address

1001 E COLORADO ST INSIDE WORLD GYM
GLENDALE CA
91205-1225
US

V. Phone/Fax

Practice location:
  • Phone: 818-919-2657
  • Fax:
Mailing address:
  • Phone: 818-919-2657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: MAHMOOD SOLEMANYI
Title or Position: OWNER
Credential: PH.D.
Phone: 818-919-2657