Provider Demographics
NPI:1225575715
Name:OLIVE TREE NUTRITION LLC
Entity Type:Organization
Organization Name:OLIVE TREE NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:RAHAF
Authorized Official - Middle Name:
Authorized Official - Last Name:AL BOCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-704-2068
Mailing Address - Street 1:7997 POTTER PL
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-8229
Mailing Address - Country:US
Mailing Address - Phone:404-704-2068
Mailing Address - Fax:
Practice Address - Street 1:7997 POTTER PL
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-8229
Practice Address - Country:US
Practice Address - Phone:404-704-2068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004367133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty