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General NPI Number Information
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NPI Number | 1295358224
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Entity Type | Organization
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Legal Business Name | FOUBLIE, INC
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Dates
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Enumeration Date | 05/26/2020
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Last Update Date | 05/26/2020
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Provider Practice Location Address
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Address Line | 1314 MASSACHUSETTS AVE NW UNIT 603
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City | WASHINGTON
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State | DC
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Zip | 20005-4812
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Country | US
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Telephone | 734-717-1992
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 HARRISON ST APT 306
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-4286
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Country | US
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Telephone | 202-873-7319
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. MELISSA ANTAL
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Credential | MPH, MBA
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Telephone | 202-873-7319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1004X
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Taxonomy Name | Pediatric Nutrition Registered Dietitian
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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