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General NPI Number Information
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NPI Number | 1528754496
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Entity Type | Organization
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Legal Business Name | STAYING AGELESS INC.
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Dates
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Enumeration Date | 04/13/2023
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Last Update Date | 04/13/2023
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Provider Practice Location Address
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Address Line | 1530 W SAM HOUSTON PKWY N STE 117
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City | HOUSTON
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State | TX
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Zip | 77043-3159
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Country | US
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Telephone | 202-719-5295
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Fax |
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Provider Business Mailing Address
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Address Line | 10780 WESTVIEW DR STE F
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City | HOUSTON
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State | TX
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Zip | 77043-5038
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Country | US
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Telephone | 202-719-5295
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Fax |
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Authorized Official
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Title or Position | CEO &CERTIFIED NUTRITION SPECIALIST
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Name | ESOSA EDOSOMWAN
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Credential | MS, CNS, LDN
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Telephone | 650-797-8890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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