Healthcare Provider Details

I. General information

NPI: 1700564366
Provider Name (Legal Business Name): MIZPAHLINK INTERNATIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4005 WINTERBERRY AVE APT 4
COVINGTON VA
24426-6325
US

IV. Provider business mailing address

4005 WINTERBERRY AVE APT 4
COVINGTON VA
24426-6325
US

V. Phone/Fax

Practice location:
  • Phone: 512-203-5563
  • Fax:
Mailing address:
  • Phone: 512-203-5563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. HARUNA ASAFOTEI
Title or Position: OWNER
Credential:
Phone: 512-203-5563