# BODY SYNTHESIS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790411445
- **Authorized official:** TAVARES ALLEN GARRETT CNC (CERTIFIED NUTRITION COACH)
- **Authorized official phone:** (818) 813-4300

## Contact information

- **Practice address:** 8439 N LAKE DR APT G, DUBLIN, CA 94568-3359
- **Practice address phone:** (818) 813-4300
- **Mailing address:** 8439 N LAKE DR APT G, DUBLIN, CA 94568-3359
- **Mailing address phone:** (818) 813-4300

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 261QH0100X | Health Service Clinic/Center | — | NULL | — |
| 302R00000X | Health Maintenance Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 07/26/2022
- **Last updated:** 07/26/2022