Provider Demographics
NPI:1043926231
Name:DR. HORINOUCHI WELLNESS CLINIC
Entity type:Organization
Organization Name:DR. HORINOUCHI WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITION SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:HORINOUCHI
Authorized Official - Suffix:
Authorized Official - Credentials:DRPH, MPH, CNS
Authorized Official - Phone:671-646-9333
Mailing Address - Street 1:226 CHALAN SAN ANTONIO
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3525
Mailing Address - Country:US
Mailing Address - Phone:671-646-9333
Mailing Address - Fax:671-646-9334
Practice Address - Street 1:226 CHALAN SAN ANTONIO
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3525
Practice Address - Country:US
Practice Address - Phone:671-646-9333
Practice Address - Fax:671-646-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty