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General NPI Number Information
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NPI Number | 1013284546
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Entity Type | Organization
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Legal Business Name | THE OLISA FOUNDATION
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Dates
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Enumeration Date | 11/29/2011
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Last Update Date | 02/02/2025
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Provider Practice Location Address
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Address Line | 7362 REMCON CIR STE 644
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City | EL PASO
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State | TX
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Zip | 79912-1623
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Country | US
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Telephone | 915-208-4431
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Fax |
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Provider Business Mailing Address
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Address Line | 3601 PICKETT RD UNIT 2121
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City | FAIRFAX
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State | VA
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Zip | 22031-8107
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Country | US
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Telephone | 915-208-4431
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. NZEDEGWU ROBERT OLISA III
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Credential | PHD, MPA, MS, MASCP
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Telephone | 202-855-3479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR1100X
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Taxonomy Name | Research Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 331L00000X
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Taxonomy Name | Blood Bank
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | RM (NRCM) 55214696
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License Number State | NM
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Taxonomy #8
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Taxonomy Code | 335G00000X
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Taxonomy Name | Medical Foods Supplier
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License Number | NAFDAC A7469L
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License Number State | ZZ
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Taxonomy #9
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | M (ASCP) 3555
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License Number State | NM
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