Healthcare Provider Details

I. General information

NPI: 1245615335
Provider Name (Legal Business Name): WELLNESS OF DC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 08/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 K ST NW STE 808
WASHINGTON DC
20037-1810
US

IV. Provider business mailing address

2141 K ST NW STE 808
WASHINGTON DC
20037-1810
US

V. Phone/Fax

Practice location:
  • Phone: 202-487-5179
  • Fax: 202-331-4969
Mailing address:
  • Phone: 202-487-5179
  • Fax: 202-331-4969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberMD9583
License Number StateDC

VIII. Authorized Official

Name: JULIAN EDWIN SAFRAN
Title or Position: OWNER
Credential: MD
Phone: 202-487-5176