| Organization Name: | DOC NUTRITION CLINIC |
| NPI Number: | 1063724193 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LISA ZOLA (CEO/OWNER) |
| Mailing Address: | 185 Center St Suite 1b Wallingford |
| State: | CT US |
| Postal Code: | 064924100 |
| Phone Number: | 2032692852 |
| Fax Number: | 2032699852 |
| NPI Enumeration Date: | 07/06/2010 |
| NPI Last Update Date: | 07/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |