Provider Demographics
NPI:1336763473
Name:FUELED BY LEO, INC.
Entity Type:Organization
Organization Name:FUELED BY LEO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LEONILA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-512-0404
Mailing Address - Street 1:4115 W FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-9001
Mailing Address - Country:US
Mailing Address - Phone:559-512-0404
Mailing Address - Fax:
Practice Address - Street 1:5100 N 6TH ST STE 135
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7506
Practice Address - Country:US
Practice Address - Phone:559-512-0404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty