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General NPI Number Information
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NPI Number | 1942068531
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Entity Type | Organization
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Legal Business Name | FUEL LIFE, PLLC
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Dates
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Enumeration Date | 03/08/2024
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 12254 QUEENSTON BLVD STE E
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City | HOUSTON
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State | TX
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Zip | 77095-5357
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Country | US
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Telephone | 832-408-0225
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Fax | 832-271-6333
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Provider Business Mailing Address
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Address Line | 16115 PORT BARROW DR
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City | CYPRESS
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State | TX
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Zip | 77429-8208
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Country | US
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Telephone | 307-250-0939
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | LAURA BROOKS
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Credential | RDN, LD
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Telephone | 307-250-0939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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