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General NPI Number Information
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NPI Number | 1720881212
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Entity Type | Organization
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Legal Business Name | O2 FITNESS AND NUTRITION
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 12609 S KROLL DR
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City | ALSIP
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State | IL
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Zip | 60803-3221
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Country | US
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Telephone | 708-969-6110
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Fax |
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Provider Business Mailing Address
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Address Line | 4839 W 121ST PL
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City | ALSIP
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State | IL
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Zip | 60803-2943
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Country | US
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Telephone | 708-819-2289
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Fax |
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Authorized Official
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Title or Position | OWNER, RDN, LDN
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Name | PAOLA AMBROSE
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Credential | BA, RDN, LDN
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Telephone | 708-819-2289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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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 | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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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 | 174200000X
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Taxonomy Name | Meals Provider
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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 | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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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 | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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