Organization
JAVAN ANTI AGING AND WELLNESS INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORINNE A PARENT PHLEBOTOMIST (IV INFUSION THERAPY)
(301) 509-5557
Entity
Organization
Contact information
Practice address
1626 U ST NW, WASHINGTON, DC 20009
(202) 868-5993
Mailing address
1626 U ST NW, WASHINGTON, DC 20009-6210
(202) 868-5993
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D0076873
LICENSE
MD
Enumeration date
11/06/2018
Last updated
11/28/2018
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