Provider Demographics
NPI:1962174086
Name:FUELED NUTRITION THERAPY
Entity type:Organization
Organization Name:FUELED NUTRITION THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:IMANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:818-633-8023
Mailing Address - Street 1:890 HAMPSHIRE RD STE E
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2873
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:890 HAMPSHIRE RD STE E
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2873
Practice Address - Country:US
Practice Address - Phone:818-633-8023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty