| Organization Name: | LIFESTYLE MEDICINE INSTITUTE |
| NPI Number: | 1669898193 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KIMBERLY PAULIEN (BUSINESS DEVELOPMENT SUPPORT) |
| Mailing Address: | 25805 Barton Rd Bldg. A, Unit 106 Loma Linda |
| State: | CA US |
| Postal Code: | 923543814 |
| Phone Number: | 9097967676 |
| Fax Number: | 9095869342 |
| NPI Enumeration Date: | 03/07/2014 |
| NPI Last Update Date: | 03/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 01107466 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |