MEDICARE: ONYE OMA BAHATI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1417448069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ONYE OMA BAHATI

Provider Business Mailing Address
First Line	:	1813 E ALTA VISTA RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-4579
Country	:	US
Telephone Number	:	602-367-3006
Fax Number	:	602-268-7453

Provider Business Practice Location Address
First Line	:	1813 E ALTA VISTA RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-4579
Country	:	US
Telephone Number	:	602-367-3006
Fax Number	:	602-268-7453

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2018
Last Update Date	:	05/18/2018

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Directions to “ ONYE OMA BAHATI ” Practice Location

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