Provider Demographics
NPI:1750836466
Name:COCOLISOPARTNERS LLC
Entity Type:Organization
Organization Name:COCOLISOPARTNERS LLC
Other - Org Name:LEANDRO PUCCI NUTRIFIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:PUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CNS, CKNS, LDN
Authorized Official - Phone:323-719-2983
Mailing Address - Street 1:1036 N LAUREL AVE
Mailing Address - Street 2:APT 4
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6030
Mailing Address - Country:US
Mailing Address - Phone:323-719-2983
Mailing Address - Fax:
Practice Address - Street 1:1036 N LAUREL AVE
Practice Address - Street 2:APT 4
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-6030
Practice Address - Country:US
Practice Address - Phone:323-719-2983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty