Provider Demographics
NPI:1386226058
Name:MAGOKORO WELLNESS LLC
Entity Type:Organization
Organization Name:MAGOKORO WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ASAKO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIHAYA
Authorized Official - Suffix:
Authorized Official - Credentials:CN
Authorized Official - Phone:503-919-8859
Mailing Address - Street 1:4320 WATER LILY LOOP UNIT 103
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-8270
Mailing Address - Country:US
Mailing Address - Phone:503-919-8859
Mailing Address - Fax:
Practice Address - Street 1:4320 WATER LILY LOOP UNIT 103
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8270
Practice Address - Country:US
Practice Address - Phone:503-919-8859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty