Organization
OMNI NUTRITION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARA L CLEVENGER RD (OWNER)
(686) 968-2170
Entity
Organization
Contact information
Practice address
404 UNITED DRIVE, NEW SMYRNA BEACH, FL 32168
(386) 968-2170
(386) 310-0587
Mailing address
3126 TAMARIND DRIVE, EDGEWATER, FL 32141-6008
(386) 968-2170
(386) 310-0587
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
ND6015
FL
Other
Enumeration date
01/23/2017
Last updated
08/11/2025
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