Provider Demographics
NPI:1932979333
Name:FUEL SHOP LLC
Entity Type:Organization
Organization Name:FUEL SHOP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGEL-QUINTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-225-7031
Mailing Address - Street 1:1584 N EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-2303
Mailing Address - Country:US
Mailing Address - Phone:909-225-7031
Mailing Address - Fax:
Practice Address - Street 1:1584 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-2303
Practice Address - Country:US
Practice Address - Phone:909-225-7031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty