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General NPI Number Information
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NPI Number | 1568936722
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Entity Type | Organization
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Legal Business Name | NUTRI LIFESTYLE INC
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Dates
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Enumeration Date | 01/21/2019
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Last Update Date | 09/21/2021
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Provider Practice Location Address
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Address Line | 5759 PARKVIEW POINT DR
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City | ORLANDO
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State | FL
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Zip | 32821-7963
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Country | US
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Telephone | 407-729-4349
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Fax |
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Provider Business Mailing Address
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Address Line | 5759 PARKVIEW POINT DR
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City | ORLANDO
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State | FL
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Zip | 32821-7963
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Country | US
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Telephone | 407-729-4349
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIA DOLORES BOHORQUEZ
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Credential | RD,LDN,CC
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Telephone | 321-948-2281
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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 | 133VN1004X
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Taxonomy Name | Pediatric Nutrition Registered Dietitian
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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 | 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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