=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265008619
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | USHINE NUTRITION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2021
-----------------------------------------------------
Last Update Date | 05/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2926 BARKER CYPRESS RD APT 5108
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77084-7939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-339-4808
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2926 BARKER CYPRESS RD APT 5108
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77084-7939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-339-4808
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. XIN GUO
-----------------------------------------------------
Credential | RD
-----------------------------------------------------
Telephone | 405-339-4808
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------