Healthcare Provider Details

I. General information

NPI: 1033861109
Provider Name (Legal Business Name): BIOBAH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 N CLASSEN BLVD STE 109
OKLAHOMA CITY OK
73106-6834
US

IV. Provider business mailing address

1330 N CLASSEN BLVD STE 109
OKLAHOMA CITY OK
73106-6834
US

V. Phone/Fax

Practice location:
  • Phone: 405-256-4823
  • Fax: 405-225-1455
Mailing address:
  • Phone: 405-256-4823
  • Fax: 405-255-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HULIAMATU BAH
Title or Position: OWNER
Credential: RD
Phone: 405-256-4823