Healthcare Provider Details

I. General information

NPI: 1386226058
Provider Name (Legal Business Name): MAGOKORO WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 WATER LILY LOOP UNIT 103
BELLINGHAM WA
98226-8270
US

IV. Provider business mailing address

4320 WATER LILY LOOP UNIT 103
BELLINGHAM WA
98226-8270
US

V. Phone/Fax

Practice location:
  • Phone: 503-919-8859
  • Fax:
Mailing address:
  • Phone: 503-919-8859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: MS. ASAKO CHIHAYA
Title or Position: OWNER
Credential: CN
Phone: 503-919-8859