Healthcare Provider Details

I. General information

NPI: 1154731230
Provider Name (Legal Business Name): CITRUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 RHODE ISLAND AVE
MC LEAN VA
22101-4919
US

IV. Provider business mailing address

1915 RHODE ISLAND AVE
MC LEAN VA
22101-4919
US

V. Phone/Fax

Practice location:
  • Phone: 202-677-5433
  • Fax:
Mailing address:
  • Phone: 202-677-5433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: DR. VANITA JAIN RAHMAN
Title or Position: OWNER
Credential: M.D., C.N.S
Phone: 202-677-5433