Provider Demographics
NPI:1154731230
Name:CITRUS LLC
Entity type:Organization
Organization Name:CITRUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VANITA
Authorized Official - Middle Name:JAIN
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, CNS
Authorized Official - Phone:202-677-5433
Mailing Address - Street 1:1915 RHODE ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4919
Mailing Address - Country:US
Mailing Address - Phone:202-677-5433
Mailing Address - Fax:
Practice Address - Street 1:1915 RHODE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4919
Practice Address - Country:US
Practice Address - Phone:202-677-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty