Provider Demographics
NPI:1386326551
Name:I HEART REAL FOOD
Entity type:Organization
Organization Name:I HEART REAL FOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:MAKETA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:CNS, LDN
Authorized Official - Phone:240-306-7400
Mailing Address - Street 1:3 CARRIAGE WALK CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-5512
Mailing Address - Country:US
Mailing Address - Phone:240-306-7400
Mailing Address - Fax:
Practice Address - Street 1:3 CARRIAGE WALK CT
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-5512
Practice Address - Country:US
Practice Address - Phone:240-306-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty