Organization
LIVELY NUTRITION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LIV LEE MS, RDN, LDN (OWNER)
(310) 867-9700
Entity
Organization
Contact information
Practice address
903 N RANDOLPH ST, PHILADELPHIA, PA 19123-1407
(310) 867-9700
Mailing address
903 N RANDOLPH ST, PHILADELPHIA, PA 19123-1407
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DN006064
PA
Other
Enumeration date
08/31/2017
Last updated
09/27/2021
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