A Balanced Life Wellness Clinic and Apothecary, LLC

Primary specialty

NutritionistTaxonomy code 133N00000X

Legal business name

A BALANCED LIFE WELLNESS CLINIC AND APOTHECARY, LLC

Practice address

1818 Library St
Ste 500
Reston, VA 20190-6242

Phone

(301) 602-1518

NPI assigned

Sep 4, 2014

Last updated

Sep 4, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Betsy Costilo

Title

President

Phone

(301) 602-1518

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1409788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409788800000",
    "number": "1629478037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1818 LIBRARY ST",
            "address_2": "STE 500",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201906242",
            "telephone_number": "301-602-1518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 LIBRARY ST",
            "address_2": "STE 500",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201906242",
            "telephone_number": "301-602-1518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A BALANCED LIFE WELLNESS CLINIC AND APOTHECARY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-04",
        "last_updated": "2014-09-04",
        "status": "A",
        "authorized_official_last_name": "COSTILO",
        "authorized_official_first_name": "BETSY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-602-1518"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sara Abdullahi, NP

• Nutritionist in Reston, VA
• Providers in Reston, VA by specialty
• Nutritionist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.