Provider Demographics
NPI:1881120319
Name:HIZA, HAZEL
Entity type:Individual
Prefix:
First Name:HAZEL
Middle Name:
Last Name:HIZA
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 1:8030 PATUXENT LANDING LOOP
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-1975
Mailing Address - Country:US
Mailing Address - Phone:301-787-4070
Mailing Address - Fax:
Practice Address - Street 1:8030 PATUXENT LANDING LOOP
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-1975
Practice Address - Country:US
Practice Address - Phone:301-787-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD710583133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist