Provider Demographics
NPI:1619709938
Name:PAMOJA ROOTED LLC
Entity type:Organization
Organization Name:PAMOJA ROOTED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NUTRITION SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARDONEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DONALD
Authorized Official - Suffix:
Authorized Official - Credentials:CNS, LDN
Authorized Official - Phone:630-518-0909
Mailing Address - Street 1:7722 CAPRON CT
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-4346
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7722 CAPRON CT
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4346
Practice Address - Country:US
Practice Address - Phone:630-518-0909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty