Provider Demographics
NPI:1083305049
Name:ANGELS FITNESS & NUTRITION LLC
Entity Type:Organization
Organization Name:ANGELS FITNESS & NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-322-9269
Mailing Address - Street 1:960 BUSTI AVE APT 409
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-2100
Mailing Address - Country:US
Mailing Address - Phone:716-322-9269
Mailing Address - Fax:
Practice Address - Street 1:960 BUSTI AVE APT 409
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-2100
Practice Address - Country:US
Practice Address - Phone:716-240-2214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service