MEDICARE: LIFEBALANCE NUTRITION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1003375080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFEBALANCE NUTRITION LLC

Provider Business Mailing Address
First Line	:	1930 ESTUARY LN
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34747-2820
Country	:	US
Telephone Number	:	724-678-9544
Fax Number	:	267-695-5612

Provider Business Practice Location Address
First Line	:	1930 ESTUARY LN
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34747-2820
Country	:	US
Telephone Number	:	724-678-9544
Fax Number	:	267-695-5612

Authorized Official
Title or Position	:	REGISTERED DIETITIAN
Name	:	CAMILIA YOUNES
Credential	:	MS, RDN, LDN, CDCES
Telephone Number	:	724-678-9544

Provider Enumeration Date	:	03/18/2019
Last Update Date	:	08/11/2021

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