Provider Demographics
NPI:1841480308
Name:WHOLE LIFE NUTRITION
Entity type:Organization
Organization Name:WHOLE LIFE NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICKA
Authorized Official - Middle Name:S
Authorized Official - Last Name:DOOLITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:RD, MPH
Authorized Official - Phone:510-499-1086
Mailing Address - Street 1:2122 LAKESHORE AVE
Mailing Address - Street 2:#602
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-1165
Mailing Address - Country:US
Mailing Address - Phone:510-499-1086
Mailing Address - Fax:
Practice Address - Street 1:4180 PARK BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1207
Practice Address - Country:US
Practice Address - Phone:510-530-5437
Practice Address - Fax:510-530-9703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty