Healthcare Provider Details

I. General information

NPI: 1801620513
Provider Name (Legal Business Name): MINDBODYSOL NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3190 N TWIN LAKES DR
AVON PARK FL
33825-9262
US

IV. Provider business mailing address

3190 N TWIN LAKES DR
AVON PARK FL
33825-9262
US

V. Phone/Fax

Practice location:
  • Phone: 863-399-1267
  • Fax:
Mailing address:
  • Phone: 863-399-1267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: SOL FIGUEROA
Title or Position: OWNER /CEO
Credential: RD/LDN, CPT
Phone: 863-399-1267