Healthcare Provider Details

I. General information

NPI: 1174313308
Provider Name (Legal Business Name): AHTRANSFORM HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2025
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 MAGNOLIA BLVD APT 206
VALLEY VILLAGE CA
91607-2518
US

IV. Provider business mailing address

12301 MAGNOLIA BLVD APT 206
VALLEY VILLAGE CA
91607-2518
US

V. Phone/Fax

Practice location:
  • Phone: 407-371-9265
  • Fax:
Mailing address:
  • Phone: 407-371-9265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDRE LUIZ ZIPPERER HABOWSKY
Title or Position: CEO
Credential:
Phone: 407-371-9265