Provider Demographics
NPI:1962717462
Name:THE REFIT KOMPLEX LLC
Entity type:Organization
Organization Name:THE REFIT KOMPLEX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KAMINI
Authorized Official - Middle Name:R
Authorized Official - Last Name:FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:LE, CPT, CGT,
Authorized Official - Phone:206-402-5040
Mailing Address - Street 1:2414 1ST AVE
Mailing Address - Street 2:SUITE 714
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1345
Mailing Address - Country:US
Mailing Address - Phone:206-402-5040
Mailing Address - Fax:
Practice Address - Street 1:504 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-402-5040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty