Healthcare Provider Details

I. General information

NPI: 1528301082
Provider Name (Legal Business Name): IZETTA CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 Q ST NE 3536
WASHINGTON DC
20002-2294
US

IV. Provider business mailing address

201 Q ST NE 3536
WASHINGTON DC
20002-2294
US

V. Phone/Fax

Practice location:
  • Phone: 314-584-9164
  • Fax:
Mailing address:
  • Phone: 314-584-9164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateDC

VIII. Authorized Official

Name: MISS AMYIA SAIHRA MCCARTHY
Title or Position: PROPRIETOR
Credential:
Phone: 314-584-9164