Provider Demographics
NPI:1568936722
Name:NUTRI LIFESTYLE INC
Entity Type:Organization
Organization Name:NUTRI LIFESTYLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:DOLORES
Authorized Official - Last Name:BOHORQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RD,LDN,CC
Authorized Official - Phone:321-948-2281
Mailing Address - Street 1:5759 PARKVIEW POINT DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-7963
Mailing Address - Country:US
Mailing Address - Phone:407-729-4349
Mailing Address - Fax:
Practice Address - Street 1:5759 PARKVIEW POINT DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32821-7963
Practice Address - Country:US
Practice Address - Phone:407-729-4349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Single Specialty