Healthcare Provider Details

I. General information

NPI: 1114777513
Provider Name (Legal Business Name): ONE STOP WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6340 SECURITY BLVD STE 100
BALTIMORE MD
21207-5284
US

IV. Provider business mailing address

6340 SECURITY BLVD STE 100
BALTIMORE MD
21207-5284
US

V. Phone/Fax

Practice location:
  • Phone: 347-455-1225
  • Fax: 410-701-7292
Mailing address:
  • Phone: 347-455-1225
  • Fax: 410-701-7292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LATIFAT RAIMI
Title or Position: PRESIDENT
Credential:
Phone: 347-455-1225