Provider Demographics
NPI:1013597764
Name:LIFEFIT NUTRITION LLC
Entity Type:Organization
Organization Name:LIFEFIT NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:P
Authorized Official - Last Name:OLIVEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:401-585-4560
Mailing Address - Street 1:1 AUGUSTA ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-1501
Mailing Address - Country:US
Mailing Address - Phone:401-585-4560
Mailing Address - Fax:
Practice Address - Street 1:1 AUGUSTA ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-1501
Practice Address - Country:US
Practice Address - Phone:401-585-4560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-08
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty