Provider Demographics
NPI:1003375080
Name:LIFEBALANCE NUTRITION LLC
Entity Type:Organization
Organization Name:LIFEBALANCE NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:CAMILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LDN, CDCES
Authorized Official - Phone:724-678-9544
Mailing Address - Street 1:1930 ESTUARY LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-2820
Mailing Address - Country:US
Mailing Address - Phone:724-678-9544
Mailing Address - Fax:267-695-5612
Practice Address - Street 1:1930 ESTUARY LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-2820
Practice Address - Country:US
Practice Address - Phone:724-678-9544
Practice Address - Fax:267-695-5612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty