Healthcare Provider Details

I. General information

NPI: 1881120319
Provider Name (Legal Business Name): HAZEL HIZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8030 PATUXENT LANDING LOOP
LAUREL MD
20724-1975
US

IV. Provider business mailing address

8030 PATUXENT LANDING LOOP
LAUREL MD
20724-1975
US

V. Phone/Fax

Practice location:
  • Phone: 301-787-4070
  • Fax:
Mailing address:
  • Phone: 301-787-4070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number710583
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number710583
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: