Provider Demographics
NPI:1720881212
Name:O2 FITNESS AND NUTRITION
Entity type:Organization
Organization Name:O2 FITNESS AND NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, RDN, LDN
Authorized Official - Prefix:
Authorized Official - First Name:PAOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMBROSE
Authorized Official - Suffix:
Authorized Official - Credentials:BA, RDN, LDN
Authorized Official - Phone:708-819-2289
Mailing Address - Street 1:4839 W 121ST PL
Mailing Address - Street 2:
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-2943
Mailing Address - Country:US
Mailing Address - Phone:708-819-2289
Mailing Address - Fax:
Practice Address - Street 1:12609 S KROLL DR
Practice Address - Street 2:
Practice Address - City:ALSIP
Practice Address - State:IL
Practice Address - Zip Code:60803-3221
Practice Address - Country:US
Practice Address - Phone:708-969-6110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No174200000XOther Service ProvidersMeals
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No302R00000XManaged Care OrganizationsHealth Maintenance Organization