Provider Demographics
NPI:1902664626
Name:XP NUTRITION AND FITNESS LLC
Entity Type:Organization
Organization Name:XP NUTRITION AND FITNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:XAVIER
Authorized Official - Middle Name:ANDRES
Authorized Official - Last Name:PANCHANA
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LDN
Authorized Official - Phone:305-200-7195
Mailing Address - Street 1:17030 NW 66TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4639
Mailing Address - Country:US
Mailing Address - Phone:305-200-7195
Mailing Address - Fax:
Practice Address - Street 1:17030 NW 66TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4639
Practice Address - Country:US
Practice Address - Phone:305-200-7195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty