Provider Demographics
NPI:1447772835
Name:TREKFIT LLC
Entity type:Organization
Organization Name:TREKFIT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:OFELIA
Authorized Official - Middle Name:BAYUTAS
Authorized Official - Last Name:MUTIA
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RDN,LD
Authorized Official - Phone:623-888-4383
Mailing Address - Street 1:9033 W STATE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-1626
Mailing Address - Country:US
Mailing Address - Phone:623-888-4383
Mailing Address - Fax:
Practice Address - Street 1:9033 WEST STATE AVENUE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305
Practice Address - Country:US
Practice Address - Phone:623-888-4383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002082133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty