Organization
O2 FITNESS AND NUTRITION
Active
Other names
My Life Fitness
Organization subpart
No
Provider details
NPI number
Authorized official
PAOLA AMBROSE BA, RDN, LDN (OWNER, RDN, LDN)
(708) 819-2289
Entity
Organization
Contact information
Practice address
12609 S KROLL DR, ALSIP, IL 60803-3221
(708) 969-6110
Mailing address
4839 W 121ST PL, ALSIP, IL 60803-2943
(708) 819-2289
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
261QH0100X
Health Service Clinic/Center
Primary
—
—
261QP3300X
Pain Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
302R00000X
Health Maintenance Organization
—
—
Other
Enumeration date
03/31/2025
Last updated
03/31/2025
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