Provider Demographics
NPI:1235483405
Name:ENERGIZE YOUR SIZE, LLC
Entity Type:Organization
Organization Name:ENERGIZE YOUR SIZE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:RICH
Authorized Official - Last Name:PALMERINO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, IBCLC
Authorized Official - Phone:703-360-1093
Mailing Address - Street 1:8237 CHANCERY CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22308-1515
Mailing Address - Country:US
Mailing Address - Phone:858-212-7239
Mailing Address - Fax:
Practice Address - Street 1:8237 CHANCERY CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22308-1515
Practice Address - Country:US
Practice Address - Phone:858-212-7239
Practice Address - Fax:703-373-3921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1821361122OtherNPI