Provider Demographics
NPI:1184357352
Name:FOCUS DIETETICS
Entity type:Organization
Organization Name:FOCUS DIETETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURGEACQ
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:319-855-0415
Mailing Address - Street 1:8221 SANDPOINT BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7252
Mailing Address - Country:US
Mailing Address - Phone:319-855-0415
Mailing Address - Fax:
Practice Address - Street 1:8221 SANDPOINT BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7252
Practice Address - Country:US
Practice Address - Phone:319-855-0415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty