Organization
BASE PERFORMANCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ETHAN OKUNAS RD, LDN (DIETITIAN/OWNER)
(508) 333-8639
Entity
Organization
Contact information
Practice address
2903 LOCH HAVEN CT, IJAMSVILLE, MD 21754-8813
(508) 333-8639
Mailing address
2903 LOCH HAVEN CT, IJAMSVILLE, MD 21754-8813
(508) 333-8639
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
06/03/2025
Last updated
06/03/2025
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