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General NPI Number Information
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NPI Number | 1578314258
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Entity Type | Organization
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Legal Business Name | CANMOOR WEIGHT LOSS - TYSONS LLC
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Dates
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Enumeration Date | 03/29/2024
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Last Update Date | 03/29/2024
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Provider Practice Location Address
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Address Line | 8313 LEESBURG PIKE # 218
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City | VIENNA
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State | VA
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Zip | 22182-2407
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Country | US
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Telephone | 206-200-0693
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Fax |
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Provider Business Mailing Address
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Address Line | 8313 LEESBURG PIKE # 218
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City | VIENNA
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State | VA
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Zip | 22182-2407
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Country | US
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Telephone | 206-200-0693
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | MR. JAMES G MOORE
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Credential |
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Telephone | 206-200-0693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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