Provider Demographics
NPI:1942068531
Name:FUEL LIFE, PLLC
Entity Type:Organization
Organization Name:FUEL LIFE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LD
Authorized Official - Phone:307-250-0939
Mailing Address - Street 1:16115 PORT BARROW DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-8208
Mailing Address - Country:US
Mailing Address - Phone:307-250-0939
Mailing Address - Fax:
Practice Address - Street 1:12254 QUEENSTON BLVD STE E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-5357
Practice Address - Country:US
Practice Address - Phone:832-408-0225
Practice Address - Fax:832-271-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service