Provider Demographics
NPI:1275263816
Name:MINDBODYPINNACLE HEALTH LLC
Entity Type:Organization
Organization Name:MINDBODYPINNACLE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP
Authorized Official - Prefix:
Authorized Official - First Name:TAIWO
Authorized Official - Middle Name:
Authorized Official - Last Name:AJANI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:301-237-2563
Mailing Address - Street 1:9430 ANNAPOLIS RD STE D
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3030
Mailing Address - Country:US
Mailing Address - Phone:443-713-8643
Mailing Address - Fax:
Practice Address - Street 1:9430 ANNAPOLIS RD STE D
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3030
Practice Address - Country:US
Practice Address - Phone:443-713-8643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty