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General NPI Number Information
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NPI Number | 1366203689
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Entity Type | Organization
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Legal Business Name | BARIWELL LIFESTYLE, LLC
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Dates
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Enumeration Date | 01/23/2024
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Last Update Date | 06/22/2026
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Provider Practice Location Address
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Address Line | 2775 DAMPIER DR
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City | MELBOURNE
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State | FL
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Zip | 32940-5600
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Country | US
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Telephone | 954-829-8822
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Fax |
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Provider Business Mailing Address
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Address Line | 130 CORRIDOR RD UNIT 704
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City | PONTE VEDRA
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State | FL
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Zip | 32004-7729
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Country | US
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Telephone | 954-829-8822
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Fax |
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Authorized Official
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Title or Position | DIETITIAN
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Name | MRS. GINA ROSENBERG
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Credential | RD
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Telephone | 954-829-8822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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