Provider Demographics
NPI:1801419817
Name:LIVE LOVE FOOD 4 LIFE
Entity Type:Organization
Organization Name:LIVE LOVE FOOD 4 LIFE
Other - Org Name:LIVE LOVE FOOD 4 LIFE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDEROS
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, MPH, CLT
Authorized Official - Phone:562-328-4202
Mailing Address - Street 1:1410 REDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-3136
Mailing Address - Country:US
Mailing Address - Phone:562-328-4202
Mailing Address - Fax:
Practice Address - Street 1:1410 REDWOOD ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-3136
Practice Address - Country:US
Practice Address - Phone:562-328-4202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service