Provider Demographics
NPI:1124420575
Name:RESET LLC
Entity type:Organization
Organization Name:RESET LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WINTANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIROS
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:410-952-2613
Mailing Address - Street 1:15121 CENTERGATE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-5714
Mailing Address - Country:US
Mailing Address - Phone:410-952-2613
Mailing Address - Fax:
Practice Address - Street 1:15121 CENTERGATE DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20905-5714
Practice Address - Country:US
Practice Address - Phone:410-952-2613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD999417133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty