1669986204 NPI number — YUMMY BODY NUTRITION

Table of content: (NPI 1669986204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669986204 NPI number — YUMMY BODY NUTRITION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YUMMY BODY NUTRITION
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:
Provider Other Organization Name Type Code:
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:
1669986204
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 HAVERFORD RD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAVERFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19041-1139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 CHESTNUT ST STE 800
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19106-2608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-416-1090
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2017

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
MY HA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
215-285-0395

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  DN005718 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1194193425 . This is a "COMMERCIAL INSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com