Provider Demographics
NPI:1417448069
Name:BAHATI, ONYE OMA
Entity Type:Individual
Prefix:
First Name:ONYE
Middle Name:OMA
Last Name:BAHATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 E ALTA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-4579
Mailing Address - Country:US
Mailing Address - Phone:602-367-3006
Mailing Address - Fax:602-268-7453
Practice Address - Street 1:1813 E ALTA VISTA RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-4579
Practice Address - Country:US
Practice Address - Phone:602-367-3006
Practice Address - Fax:602-268-7453
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty