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General NPI Number Information
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NPI Number | 1932784998
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Entity Type | Organization
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Legal Business Name | BUSHIDO BARIATRIC CENTER
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Dates
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Enumeration Date | 03/11/2021
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Last Update Date | 03/11/2021
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Provider Practice Location Address
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Address Line | 402 N WEST ST
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City | FALLS CHURCH
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State | VA
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Zip | 22046-2543
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Country | US
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Telephone | 907-350-5571
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Fax |
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Provider Business Mailing Address
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Address Line | 402 N WEST ST
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City | FALLS CHURCH
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State | VA
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Zip | 22046-2543
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Country | US
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Telephone | 907-350-5571
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Fax |
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Authorized Official
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Title or Position | SURGEON
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Name | DR. LISSA CHRISTINA SAKATA
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Credential | MD, MPH
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Telephone | 907-350-5571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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