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General NPI Number Information
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NPI Number | 1205630852
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Entity Type | Organization
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Legal Business Name | FITNESS360
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Dates
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Enumeration Date | 04/02/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 1574 TAMARIX ST
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City | CAMARILLO
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State | CA
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Zip | 93010-1945
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Country | US
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Telephone | 805-607-9515
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Fax |
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Provider Business Mailing Address
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Address Line | 1574 TAMARIX ST
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City | CAMARILLO
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State | CA
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Zip | 93010-1945
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | NICOLE BURBOA
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Credential |
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Telephone | 805-607-9515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207RA0201X
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Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
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License Number |
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License Number State |
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