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General NPI Number Information
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NPI Number | 1790417772
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Entity Type | Organization
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Legal Business Name | WELLNESS CUBE LLC
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Dates
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Enumeration Date | 06/28/2022
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 9131 PISCATAWAY RD STE 150
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City | CLINTON
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State | MD
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Zip | 20735-2510
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Country | US
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Telephone | 202-365-1120
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Fax |
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Provider Business Mailing Address
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Address Line | 9131 PISCATAWAY RD STE 150
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City | CLINTON
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State | MD
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Zip | 20735-2510
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Country | US
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Telephone | 202-365-1120
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TAMEKA GABOUREL-ANTHONY
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Credential |
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Telephone | 202-262-0916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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