1861086985 NPI number — WAZOBIAN HOLDINGS LLC

Table of content: (NPI 1861086985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861086985 NPI number — WAZOBIAN HOLDINGS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAZOBIAN HOLDINGS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADANNA IBE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861086985
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2601 PARK CENTER DR APT C703
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22302-1477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-751-0691
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9244 E HAMPTON DR STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAPITOL HEIGHTS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20743-3830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-473-2955
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/01/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
IBE
Authorized Official First Name:
ADANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
REGISTERED DIETITIAN NUTRITIONIST
Authorized Official Telephone Number:
240-751-0591

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 133VN1004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133VN1005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133VN1101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DI100001161 . This is a "DC DIETETICS LICENSE NUMBER" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 1086540 . This is a "CDR REGISTRATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: DX3953 . This is a "MARYLAND DIETETICS LICENSE NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".