Provider Demographics
NPI:1922825934
Name:SOUL OF NUTRITION AND FITNESS LLC
Entity type:Organization
Organization Name:SOUL OF NUTRITION AND FITNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:MAKAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CNS, LDN, CN
Authorized Official - Phone:510-557-2727
Mailing Address - Street 1:35111F NEWARK BLVD UNIT 487
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-1219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34224 GADWALL CMN
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-3001
Practice Address - Country:US
Practice Address - Phone:510-557-2727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-21
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center