Provider Demographics
NPI:1033569314
Name:VIDA NUTRITION, LLC
Entity Type:Organization
Organization Name:VIDA NUTRITION, LLC
Other - Org Name:VIDA NUTRITION AND CONSCIOUS LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:DINA
Authorized Official - Middle Name:M BLANKENBERGER
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:786-479-4081
Mailing Address - Street 1:20216 INDIAN ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3485
Mailing Address - Country:US
Mailing Address - Phone:786-479-4081
Mailing Address - Fax:786-923-0949
Practice Address - Street 1:20216 INDIAN ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3485
Practice Address - Country:US
Practice Address - Phone:786-479-4081
Practice Address - Fax:786-923-0949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GY620AMedicare UPIN