Provider Demographics
NPI:1790045425
Name:MIGRAINE FREE HOLISTICALLY
Entity type:Organization
Organization Name:MIGRAINE FREE HOLISTICALLY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HOLISTIC HEALTHCARE PRACTITIONER CE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:YOUSSEF
Authorized Official - Last Name:ABBOUD
Authorized Official - Suffix:
Authorized Official - Credentials:NE
Authorized Official - Phone:650-369-1958
Mailing Address - Street 1:767 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-2274
Mailing Address - Country:US
Mailing Address - Phone:650-369-1958
Mailing Address - Fax:650-369-1958
Practice Address - Street 1:767 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-2274
Practice Address - Country:US
Practice Address - Phone:650-369-1958
Practice Address - Fax:650-369-1958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty