Healthcare Provider Details

I. General information

NPI: 1568936722
Provider Name (Legal Business Name): NUTRI LIFESTYLE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2019
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5759 PARKVIEW POINT DR
ORLANDO FL
32821-7963
US

IV. Provider business mailing address

5759 PARKVIEW POINT DR
ORLANDO FL
32821-7963
US

V. Phone/Fax

Practice location:
  • Phone: 407-729-4349
  • Fax:
Mailing address:
  • Phone: 407-729-4349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MARIA DOLORES BOHORQUEZ
Title or Position: PRESIDENT
Credential: RD,LDN,CC
Phone: 321-948-2281